Medium-term and Long-term Follow-up Surgical Outcomes of the 1-stage Posterior-only Lumbosacral Hemivertebra Resection With Short-segment Fusion in Children

Background:The objective of this study was to evaluate the medium-term and long-term surgical outcomes of the 1-stage posterior-only lumbosacral hemivertebra resection with short-segment fusion in children. Methods:This retrospective chart review included 21 children with congenital scoliosis due to lumbosacral hemivertebra who received 1-stage posterior-only hemivertebra resection with short-segment fusion from 2012 to 2016 with at least 5 years of follow-up. Standing anteroposterior and lateral radiographs of the spine were compared preoperatively, postoperatively, and at last follow-up. Radiographic evaluation included measured changes in segmental scoliosis and lordosis, compensatory scoliosis, thoracic kyphosis, lumbar lordosis, trunk shift, and sagittal spinopelvic alignment. Results:There were 12 boys and 9 girls with a mean age of 6.5 +/- 3.2 years. The mean follow-up period was 6.7 +/- 1.3 years. The mean fusion level was 2.7 +/- 0.9 segments. The mean segmental scoliosis was 29 +/- 6 degrees preoperatively, 9 +/- 3 degrees (correction rate of 71%) postoperatively (P < 0.05), and 7 +/- 3 degrees (correction rate of 76%) at the latest follow-up. The compensatory curve of 26 +/- 12 degrees was spontaneously corrected to 14 +/- 8 degrees (correction rate of 47%) at last follow-up (P < 0.05). Trunk shift was significantly improved on both coronal (53%) and sagittal (56%) planes after surgery (P < 0.05) and stable at follow-up. The sagittal spinopelvic alignment was balanced in all cases. There were no neurological or infectious complications. Conclusions:It is safe and effective to perform 1-stage posterior-only lumbosacral hemivertebra resection with short-segment fusion, which can significantly correct the segmental scoliosis, prevent the compensatory curve progress and improve the trunk shift. This strategy also can save motion segments and avoid long lumbar fusion. Medium-term and long-term follow-up outcomes are satisfactory.