Resection of hemivertebra and anterior intervertebral osteotomy combined with posterior correction in treating serious congenital scoliosis / 中华骨科杂志

ABSTRACT

Objective To discuss the clinical outcomes of two-stage anterior osteotomy and posterior correction to serious congenital scoliosis in children. Methods 14 patients with serious congenital scoliosis was typeⅠin 2 cases, type Ⅱin 6 cases, and combination of type Ⅰ and Ⅱ in 6 cases according to MacEwen's classification. There were 4 boys and 10 girls, and the age was ranged from 8 to 13 years with a mean of 11.2 years. The preoperative coronal Cobb's angle was ranged from 63? to 95? with an average of 72.1?. The hemivertebra ranging from T2 to L4. All cases were treated by anterior osteotomy, resection of hemivertebrae, and release of unilateral unsegmented bar, combined with posterior correction, and fusion with bone graft. The average range of osteotomy was 5.5 segments in anterior procedure, and all the patients were instrumented with pedicle screws in posterior procedure. Results In this group, the blood loss was 300 to 500 ml in first stage and 700 to 1200 ml in second stage respectively. After the first-stage surgery, the coronal Cobb's angle was ranged from 48? to 60? with a mean of 51.5?, and the correction rate ranged from 19.6% to 37.8% with an average of 28.6%. After the second-stage surgery, the Cobb's angle was ranged from 5? to 45? with a mean of 30.5? and the correction rate was from 52.6% to 87.5% with an average of 62.5%. All cases were followed up for 8 to 30 months (mean, 12.1 months). There were no loss of correction and major complications of the fixations, and the spinal fusions were excellent. Complications were observed in 2 cases, one was the loosening of the screw cap, and another was the T1 radicular pain after operations. Conclusion The combined anterior and posterior approach is an effective technique for serious congenital scoliosis in children of 8 to 12 years.