title: Multiple cervical hemivertebra resection and staged thoracic pedicle subtraction osteotomy in the treatment of complicated congenital scoliosis.
abstract: To present our experience of staged correction with multiple cervical hemivertebra resection and thoracic pedicle subtraction osteotomy (PSO) treating a rare and complicated congenital scoliosis.
  
  
  
  A 14-year-old male presented with progressive torticollis and spine deformity. The malformation developed since birth, and back pain after long-time sitting or exercise arose since 6 months before, which was unsuccessfully treated by physiotherapy. X-ray showed a right cervical curve of 60° and a left compensatory thoracic curve of 90°. Three-dimensional computed tomography (3-D CT) scan revealed three semi-segmented hemivertebrae (C4, C5 and C6) on the right side. Based on our staged strategy, the three consecutive cervical hemivertebrae, as the major pathology causing the deformity, were firstly resected by the combined posterior and anterior approach. Six months later, T6 PSO osteotomy was used to correct the structural compensatory thoracic curve.
  
  
  
  The cervical curve was reduced to 23° while the thoracic curve to 60° after the first-stage surgery, and the thoracic curve was further reduced to 30° after the second-stage surgery. The radiograph at 5-year follow-up showed that both the coronal and sagittal balance were well restored and stabilized, with the occipital tilt reduced from 12° to 0°.
  
  
  
  Our strategy may provide an option for similar cases with multiple consecutive cervical hemivertebrae and a large structural compensatory thoracic curve, which proved to achieve excellent correction in both the coronal and sagittal planes with acceptable neurologic risk.
authors.affiliation: Department of Orthopedics, Peking Union Medical College Hospital, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, People's Republic of 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, People's Republic of 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, People's Republic of 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, People's Republic of 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, People's Republic of China.
authors.forename: Guixing
authors.initials: G
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D001416:Back Pain / Q000209:etiology; D002574:Cervical Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D004413:Dysostoses / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015444:Exercise; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000151:congenital / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Congenital cervical scoliosis; Hemivertebra resection; Multiple cervical hemivertebrae; Pedicle subtraction osteotomy; Two-stage correction