Posterior-only Hemivertebra Resection for Congenital Cervicothoracic Scoliosis Correcting Neck Tilt and Balancing the Shoulders

Study Design. A retrospective study. Objective. To evaluate radiographic and cosmetic outcomes after posterior-only cervicothoracic hemivertebra resection and instrumentation. Summary of Background Data. Cervicothoracic hemivertebra is a rare congenital deformity. It locates between the mobile cervical spine and the fixed thoracic spine, leading to rapid curve progression, shoulder imbalance, fixed torticollis, and facial asymmetry. Methods. This study reviewed a consecutive series of 18 patients with cervicothoracic hemivertebra. All received posterior-only hemivertebra resection and instrumentation and had a minimum follow up of 2 years. Assessments on radiographic and cosmetic outcomes were based on changes in measurements of scoliosis, shoulder balance, neck tilt, head shift, and sagittal profiles. Results. There were 24 hemivertebrae, consisting of 16 fully segmented and 8 semisegmented. Mean age at surgery was 9.5 +/- 3.1 years, and mean follow up was 32 +/- 10 months. Mean fusion segments were 4.8 +/- 0.6 segments. Operation time averaged 208 +/- 33 minutes, with an average blood loss of 384 +/- 40mL. Local scoliosis was corrected from 39 +/- 58 to 16 +/- 48 (P < 0.001). The distal curve had a spontaneous correction of 41 +/- 18%. With regards to shoulder balance, both T1 tilt and clavicle angle were significantly improved, with a correction rate of 55 +/- 22% and 47 +/- 32%, respectively. Accordingly, neck tilt was improved from 20 +/- 7 degrees to 11 +/- 7 degrees, and head shift from 22 +/- 9mm to 13 +/- 8 mm. A remarkable pedicle screw malpositioning rate (20%) was observed, but no neurovascular injuries. One case developed with Horner syndrome, and another one had transient radicular pain on the right arm after surgery. Conclusion. For patients with congenital cervicothoracic scoliosis, posterior-only hemivertebra resection with instrumentation allows for excellent scoliosis correction and cosmetic improvement. Great care should be taken to reduce the rate of pedicle screw malpositioning.