title: One-stage posterior-only lumbosacral hemivertebra resection with short segmental fusion: a more than 2-year follow-up.
abstract: Lumbosacral hemivertebra poses a unique problem because it can cause gross imbalance and progressive compensatory thoracolumbar deformity. Previous studies have reported lumbosacral hemivertebra resection through a combined anterior and posterior approach, but there have been no reports on the results and complications of hemivertebra resection via a posterior-only procedure and short fusion with large series of patients.
  
  
  
  This retrospective study of a prospective collected database comprises a consecutive series of 14 congenital scoliosis due to lumbosacral hemivertebra treated by 1-stage posterior hemivertebra resection with short segmental fusion, with at least a 2-year follow-up period (24-144 months). Surgical reports and patient charts were reviewed. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, and trunk shift. Quality of life data from Scoliosis Research Society (SRS)-22 questionnaires were also collected.
  
  
  
  Our results showed that the mean follow-up period was 38.4 months. The mean fusion level was 3.2 segments. Mean operation time was 207.8 min with the average blood loss of 235.7 ml. The mean segmental scoliosis was 30° preoperatively, 5° postoperatively (83 % correction rate), and 4° (87 %) at the latest follow-up. The compensatory coronal curve of 30° was spontaneously corrected to 13° at most recent follow-up. Trunk shift was significantly improved on both coronal (63 %) and sagittal plane (58 %) after the surgery, and kept stable during the follow-up. The total SRS-22 score, the self-image domain score and the satisfaction domain score demonstrated significant improvement compared with preoperative status. Only one intra-operative complication was observed, a pedicle fracture.
  
  
  
  In summary, our results showed that one-stage HV resection and short segment fusion by a posterior approach can offer excellent scoliosis correction and trunk shift improvement without neurological complications, while saving motion segments as much as possible. This strategy is not only corrective of the deformity but also preventive of compensatory curve progression, thus avoiding long lumbar fusion.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Qianyu
authors.initials: Q
authors.lastname: Zhuang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China. jgzhang_pumch@yahoo.com.
authors.forename: Jianguo
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Shugang
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Shengru
authors.initials: S
authors.lastname: Wang
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Guo
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
authors.forename: Guixing
authors.initials: G
authors.lastname: Qiu
mesh_terms: D016063:Blood Loss, Surgical; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D061646:Operative Time; D017060:Patient Satisfaction; D011788:Quality of Life; D012189:Retrospective Studies; D012447:Sacrum / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*
keywords: Congenital scoliosis; Lumbosacral hemivertebra; One stage; Posterior approach; Short segmental fusion