title: Hemivertebra Resection With Instrumented Fusion by Posterior Approach in Children.
abstract: METHODS
  We conducted a retrospective study of patients with congenital scoliosis due to hemivertebra (HV) and performed resection with instrumentation through posterior approach-only with long term follow-up.
  
  
  OBJECTIVE
  The objective of this study was to assess results of HV resection by posterior approach-only with instrumentation between 2002 and 2011.
  
  
  BACKGROUND
  Hemiepiphysiodesis, arthrodesis in situ and resection without instrumentation had been performed in the past with different results. Hemivertebra resection with spinal instrumentation through anterior and posterior approach has been advocated as the treatment of choice.
  
  
  METHODS
  A total of 67 patients with 78 HV and 70 surgical procedures were evaluated. Thirty-five of the patients were females and 32 were males. The mean age of the patients was 5.5 years (from 0.8 to 16 yr), and the mean follow-up period was 6.55 years (from 2.1 to 10.8 yr). Eighteen patients presented additional pathologies: specific syndromes, cardiopathies, thoracic, abdominal, and bone malformations. Sixteen patients had partial HV while 51 had full mobility HV. Twenty-eight of the HV were thoracic, 16 thoracolumbar, 28 lumbar, and six lumbosacral.
  
  
  RESULTS
  The scoliosis mean preoperative angular value was 38.55°, and the mean postoperative angular value was 19.89°. The kyphosis mean preoperative angular value was 29.98° and the mean postoperative angular value was 15.41°. One rod was used in 38 surgical procedures (54.28%) and 2 rods in 32 procedures (45.72%). We used monoaxial screws in 45 patients, poliaxial screws in 17 patients, and both monoaxial screws and poliaxial screws in one patient. Screws and hooks were used in one patient and hooks in three patients. Arthrodesis was performed in 64 patients, and no complications were registered in those without arthrodesis. Postoperative orthesis was used in 57 opportunities. Several complications during or after HV resection by posterior approach-only were reported. Two patients suffered from intraoperative neurophysiological complications, which were resolved during surgery with minimum gestures and presented no sequelae. Two patients developed superficial infections and needed toilette and IV antibiotic therapy. Two patients needed an additional surgery due to secondary curves, 4.9 yr after primary surgery on average. One patient developed crankshaft.
  
  
  CONCLUSIONS
  We concluded that HV resection by posterior approach-only with instrumentation is a simple, secure, reliable, less invasive and well tolerated technique that can successfully resolve this kind of congenital scoliosis in children.
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina. Electronic address: lucaspiantoni@hotmail.com.
authors.forename: Lucas
authors.initials: L
authors.lastname: Piantoni
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Ida A
authors.initials: IA
authors.lastname: Francheri Wilson
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Tello
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Mariano A
authors.initials: MA
authors.lastname: Noel
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Galaretto
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Rodrigo G
authors.initials: RG
authors.lastname: Remondino
authors.affiliation: Servicio de Patología Espinal, Hospital Nacional de Pediatría, Prof. Dr. Juan P. Garrahan C.A.B.A., Buenos Aires, Argentina.
authors.forename: Ernesto S
authors.initials: ES
authors.lastname: Bersusky
keywords: Congenital scoliosis; Early-onset scoliosis; Hemivertebra resection; Pediatric spine surgery; Vertebrae malformation