One-stage posterior excision of lumbosacral hemivertebrae

Abstract

Lumbosacral hemivertebrae causes unique problems as early trunk decompensation and long compensatory curve above. There are only a few reports on it. This case series is a fair supplement in the literatures. To evaluate the clinical and radiological outcomes of lumbosacral hemivertebrae resection through 1-stage posterior approach. Between 2005 and 2014, a consecutive series of congenital scoliosis due to lumbosacral hemivertebrae underwent hemivertebrae excision through 1-stage posterior only approach. Demographic, operative, radiological, and quality of life data were reviewed. The mean lumbosacral curve was 29±7° preoperatively, 10±3° postoperatively, and 13±5° at the final follow up. The final correction rate was 55±9%. The gravity trunk shift was 11±3mm preoperatively, 37±12mm (range, 6-49mm) postoperatively, 14±9mm at final follow up. The rib cage shift was 36±12mm preoperatively, 19±5mm postoperatively, and 15±4mm at the final follow up. The mean blood loss was 527±125mL and the mean surgery time was 336±98minutes. The mean follow up period was 41±6 months. Two patients underwent transient neurological complications, 2 had wound bad healing, and 1 got wound infection. No pseudoarthrosis and instrumentation failure was observed. One-stage posterior hemivertebrae excision could gain reasonable outcome. It is crucial to completely resect the hemivertebrae and the Y-shaped disc. Bending the rod to appropriate lordosis is helpful to close the convex side. Early surgical intervene is a preferred choice to restore the trunk balance and avoid extensive fusion. The neurological complication rate is high. Convex radiculopathy is often caused by retraction, it could recover at follow up.