New Technique in Congenital Scoliosis Involving Fixation to the Pelvis After Hemivertebra Excision

Abstract

In Brief Study Design. The authors conducted a retrospective study involving description of a new surgical technique. Objectives. The objective of this study was to describe and evaluate the efficacy of a new technique to stabilize the spine of young and small patients with congenital scoliosis after lumbosacral hemivertebra excision. Summary of Background Data. Congenital scoliosis develops as the result of anomalous vertebral development and asymmetric growth. The vertebral anomalies include congenital fusions and congenital hemivertebrae. With lumbosacral hemivertebrae at the lumbosacral junction, surgical excision followed by instrumentation to close the resulting space is frequently the best way to correct the deformity and obtain spinal balance. Surgical stabilization is required for preventing recurrent deformity and restoration of spinal balance. Methods. A new surgical technique for spinal correction and stabilization in congenital scoliosis is described. The technique involves hemivertebra excision followed by fixation of the adjacent normal vertebra to the ilium with screws and cables. This technique allows efficient correction in both the coronal and sagittal planes. Results. This construct was prospectively studied in 3 cases over a 3- to 51/2-year period. All cases had solid fusion and well-balanced spine at latest follow up. Conclusions. This prospective study demonstrates a successful surgical technique for spinal stabilization after congenital hemivertebra excision in infants and young children with relatively small and soft bones when standard constructs like pedicle screws may not be optimal devices. Coronal and sagittal balance (restoration with improvement of lordosis) was successfully achieved in all cases. A retrospective study involving results of a new technique of surgical stabilization in congenital scoliosis after hemivertebra excision is presented. Biomechanical analysis of the construct, technique of surgery, and rationale for use in infants children is discussed. Follow up of patients with outcome is presented with recommendations for successful outcome.