Hemivertebra Resection Combined With Wedge Osteotomy for the Treatment of Severe Rigid Congenital Kyphoscoliosis in Adolescence

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1 Hemivertebra Resection Combined With Wedge Osteotomy for the Treatment of Severe Rigid Congenital Kyphoscoliosis in Adolescence Comparison of Clinical, Radiographic, and Health-Related Quality of Life Outcomes Between the Hemivertebra Resection only and Hemivertebra Resection Combined with Wedge Osteotomy Liu Zhongkai Hao Dingjun He Baorong Department of Spinal Deformity, HongHui Hospital, Xi an Jiaotong University College of Medicine, Xi an, Shaanxi , China

2 Objective To compare clinical, radiographic, and health-related quality of life (Scoliosis Research Society [SRS]-24) outcomes in adolescent patients undergoing hemivertebra resection only (HR) or hemivertebra resection combined with wedge osteotomy (HRWO). And evaluate the surgical outcomes of adolescent patients with hemivertebra treated by hemivertebra resection combined with wedge osteotomy (HRWO).

3 HRWO allows for radiographical correction that surpasses that reported for HR. The average intraoperative blood loss was764 ml (range, ml) in A and 980 ml (range, ml) in B group (P= 0.41, NS). The average operation times were 4.3 hours (range, hours) and 5.4 hours (range, hours), respectively (P= 0.62, NS). There were no neurological complications.

4 Figure 1.HRWO is Hemivertebra Resection Combined With Wedge Osteotomy, that is, V shaped bone resection of the adjacent vertebral body, including the hemivertebral body, the upper and lower disc, both endplate of adjacent segments, spinous process, bilamina, facet joint.

5 HRWO=2 Grade 4 osteotomy * Grade 4 osteotomy, pedicle, partial body and disc resection Frank Schwab, MD,Benjamin Blondel, MD,Edward Chay, BA et al. The Comprehensive Anatomical Spinal Osteotomy Classification. Neurosurgery 74: , 2014

6 Figure 2. In comparison, the 7 domains of SRS-24 have gained similar results between HR and HRWO. The most significant change during the follow-up in both groups can be seen in the general activity and postoperative function. A, Postoperative. The P value for the difference in satisfaction between the groups is B, FFU. The P value for the difference in General Activity between the groups is 0.32.

7 Figure 3. Radiographs of patient 18, a 16-year-old girl, who underwent hemivertebra excision Combined With Wedge Osteotomy surgery for hemivertebrae L2 (A) Preoperative PA, (B) FFU PA, (C) Preoperative lateral, (D) FFU lateral.

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9 Conclusion. Hemivertebra resection, combined with WO(HRWO), through a single posterior approach is a technically challenging but safe and effective procedure for severe rigid kyphoscoliosis, especially in an adolescent patient with fixed kyphoscoliotic deformity. This posterior-only approach allows for dramatic radiographical correction that surpasses that reported for HR.

10 REFERENCES Cheung KM, Zhang JG, Lu DS, K Luk KD, Y Leong JC (2002) Ten-year follow-up study of lower thoracic hemivertebrae treated by convex fusion and concave distraction. Spine 27(7): doi: / McMaster MJ, Singh H, Natural history of congenital kyphosis and kyphoscoliosis (1999) A study of one hundred and twelve patients. J Bone Joint Surg Am 81(10): Winter RB (1976) Congenital kyphoscoliosis with paralysis following hemivertebra excision. Clin Orthop Relat Res (119): McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Joint Surg 1982;64A: O Brien MF, Kuklo TR, Blanke KM, et al, eds; Spinal Deformity Study Group. Radiographic Measurement Manual. Memphis, TN: Medtronic Sofamor Danek Inc; Jalanko T, Rintala R, Puisto V, Helenius I (2010) Hemivertebra resection for congenital scoliosis in young children. Comparison of clinical, radiographic, and health related quality of life outcomes between the anteroposterior and posterolateral approaches. Spine 36(1):41 49 Yan Wang. A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J (2008) 17: ;93: DOI /s

11 Thank you!