Xue Xuhong, Zhao Sheng
Department of Orthopedics, The Second Hospital, Shanxi Medical University, Taiyuan, Shanxi, P.R. China.
Medicine (Baltimore). 2017 Dec;96(48):e8794. doi: 10.1097/MD.0000000000008794.
Hemivertebrae, which are the most frequent cause of congenital scoliosis, pose a challenge in terms of prognosis and therapy. The current gold standard treatment congenital scoliosis due to a lumbar and thoracic hemivertebra would be hemivertebra resection and short level posterior spinal fusion. Paucity literatures are reported for the treatment of hemivertebra by convex fusion with posterior hemivertebra excision.
The patient was first noticed to have a spinal problem at 7 years of age. A radiograph showed two full segment hemivertebra respectively at T10, between L4 and L5, with the spine deviating to the right side. No treatment was given, but he was followed with serial radiographs. At the 15 month follow up, a surgery was performed due to scoliosis progression, consisting of a unilateral instrumentation from L4 to L5 without hemivertebrectomy or epiphysiodesis. One year after surgery, the thoracic curve became larger and larger and hump started to progress as he grew.
Congenital scoliosis; Full segment hemivertebra at T10 and L4/5.
The full segment hemivertebra between L4 and L5 was excised and fusion in revision procedure. Transpedicular screws were inserted on the convex side in L4 and S1 and a rod was applied. A chart and radiological review were record at 8 years after final surgery.
Eight years after the final surgery, the patient was completely pain-free, motion of the lumbar spine was preserved and the physiological curvatures were maintained. Good coronal and sagittal alignment of the spine was observed clinically and radiographically.
In summary, our case showed that unilateral instrumentation without hemivertebrectomy can result in an unacceptable deformity. However, the excellent outcome can be achieved when hemivertebra was excised. Although this is only a single case, the good result with a long follow-up suggests the technique is worthwhile for very young children with lumbosacral hemivertebra. Early recognition and resection combined with limited fusion were needed for these patients.
半椎体是先天性脊柱侧凸最常见的病因，在预后和治疗方面具有挑战性。目前治疗腰椎和胸椎半椎体所致先天性脊柱侧凸的金标准是半椎体切除及短节段后路脊柱融合术。关于通过后路半椎体切除凸侧融合治疗半椎体的文献报道较少。
患者7岁时首次被发现有脊柱问题。X线片显示T10、L4和L5之间分别有两个全节段半椎体，脊柱向右侧偏斜。未进行治疗，但定期进行X线片随访。在15个月的随访中，由于脊柱侧凸进展进行了手术，手术包括从L4到L5的单侧内固定，未进行半椎体切除术或骨骺阻滞术。术后1年，随着生长，胸弯越来越大，驼背开始加重。
先天性脊柱侧凸；T10和L4/5全节段半椎体。
切除L4和L5之间的全节段半椎体并在翻修手术中进行融合。在L4和S1的凸侧置入椎弓根螺钉并安装棒。在最后一次手术后8年记录图表和影像学检查结果。
最后一次手术后8年，患者完全无痛，腰椎活动得以保留，生理曲度得以维持。临床和影像学检查均观察到脊柱在冠状面和矢状面排列良好。
总之，我们的病例表明，不进行半椎体切除术的单侧内固定可能导致不可接受的畸形。然而，切除半椎体可取得良好效果。尽管这只是一个病例，但长期随访的良好结果表明，该技术对于患有腰骶部半椎体的幼儿是值得的。这些患者需要早期识别、切除并结合有限融合。
