title: Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques.
abstract: METHODS
  Multicenter, retrospective study.
  
  
  OBJECTIVE
  To compare the outcomes of three surgical treatments for congenital spinal deformity due to a hemivertebra.
  
  
  BACKGROUND
  Congenital anomalies of the spine can cause significant and progressive scoliosis and kyphosis. Their management may be challenging and controversy remains over the "best" surgical treatment.
  
  
  METHODS
  A multicenter retrospective study of patients with congenital spinal deformity due to 1 or 2 level hemivertebra(e) was performed. The surgical treatments included hemiepiphysiodesis or in situ fusion (group 1), instrumented fusion without hemivertebra excision (group 2), or instrumented hemivertebra excision (group 3).
  
  
  RESULTS
  Seventy-six patients with minimum 2-year follow-up were evaluated. The mean age was 8 years (range: 1-18). The hemivertebra were fully segmented, nonincarcerated (67%), incarcerated (1%), and semisegmented (32%). There were 65 patients with single hemivertebra and 11 patients with double hemivertebra. There were 14 (18.4%) group 1, 20 (26.3%) group 2, and 42 (55.3%) group 3 patients. Group 1 (37 ± 14°) and group 3 (35 ± 26°) patients had smaller preoperative curves than group 2 patients (55 ± 26°) (P < 0.01). Group 3 had better percent correction at 2 years than groups 1 and 2 (P < 0.001). Group 3 had shorter fusion (P = 0.001), less estimated blood loss (EBL, P = 0.03), and a trend toward shorter operative times than group 2 (P = 0.10). The overall complication rate for the entire group was 30% group 1 (23%), group 2 (17%), and group 3 (44%) (P = 0.09).
  
  
  CONCLUSIONS
  While hemivertebra resection for congenital scoliosis had a higher complication rate than either hemiepiphysiodesis/in situ fusion or instrumentated fusion without resection, posterior hemivertebra resection in younger patients resulted in better percent correction than the other two techniques.
authors: Orthopedic Surgery, Rady Children's Hospital, San Diego, CA, USA. byaszay@rchsd.org
authors: Burt
authors: B
authors: Yaszay
authors: Michael
authors: M
authors: O'Brien
authors: Harry L
authors: HL
authors: Shufflebarger
authors: Randal R
authors: RR
authors: Betz
authors: Baron
authors: B
authors: Lonner
authors: Suken A
authors: SA
authors: Shah
authors: Oheneba
authors: O
authors: Boachie-Adjei
authors: Alvin
authors: A
authors: Crawford
authors: Lynn
authors: L
authors: Letko
authors: Jurgen
authors: J
authors: Harms
authors: Munish C
authors: MC
authors: Gupta
authors: Paul D
authors: PD
authors: Sponseller
authors: Mark F
authors: MF
authors: Abel
authors: John
authors: J
authors: Flynn
authors: Angel
authors: A
authors: Macagno
authors: Peter O
authors: PO
authors: Newton
mesh_terms: D000293:Adolescent; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013131:Spine / Q000002:abnormalities* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome