Zhao Yiwei, Zhang Haoran, Du You, Li Chenkai, Lin Guanfeng, Yang Yang, Sun Dihan, Zhang Jianguo, Wang Shengru
J Neurosurg Spine. 2025 Aug 8:1-8. doi: 10.3171/2025.4.SPINE24936.
Congenital early-onset scoliosis (CEOS) resulting from hemivertebra requires early intervention if severe deformity is indicated. For a single hemivertebra, posterior hemivertebra resection and monosegment fusion can correct the deformity with minimal involvement of the spinal segment. Previous studies have shown that this technique is safe and effective, although most of the enrolled patients had not yet reached skeletal maturity. Because CEOS is a developmental condition, the ultimate clinical outcomes can only be determined once spinal growth is complete. Therefore, the authors conducted a long-term follow-up study in which all patients reached skeletal maturity to evaluate the outcomes of hemivertebra resection and monosegment fusion.
A retrospective study of CEOS patients treated with posterior hemivertebra resection and monosegment fusion was conducted between 2007 and 2017. At the latest follow-up, all patients had reached skeletal maturity (Risser sign ≥ 4 and age ≥ 14 years), with a mean ± SD follow-up duration of 10.5 ± 2.5 years. Demographic characteristics, coronal and sagittal deformity correction parameters, spinal and vertebral growth parameters, 22-item Scoliosis Research Society (SRS)-22 scores, and complications were analyzed.
A total of 23 patients (15 males and 8 females) were enrolled, and the mean age was 4.8 ± 2.0 years. The preoperative main curve was 32.3° ± 14.4°, which significantly decreased to 7.3° ± 6.5° postoperatively, with a 15.4% loss of correction during follow-up. Sagittal kyphosis significantly improved and was maintained at the latest follow-up. Three patients had coronal imbalance preoperatively, which decreased to 1 patient at the latest follow-up. The T1-12 and T1-S1 heights increased from 15.9 ± 1.6 cm and 27.1 ± 1.7 cm preoperatively to 24.0 ± 2.2 cm and 37.3 ± 3.1 cm at the latest follow-up, respectively. The increase in vertebral body height and interpedicular length was comparable between instrumented vertebrae and noninstrumented vertebrae. The SRS-22 total score was 4.3 ± 0.2 at the latest follow-up. A total of 10 complications occurred in 7 patients.
Over long-term follow-up to skeletal maturity, the use of hemivertebra resection and monosegment fusion was a safe and effective surgical approach for single hemivertebra. Deformity correction was well maintained without detrimental effects on spinal growth and achieved acceptable patient-reported clinical outcomes.
如果显示有严重畸形，由半椎体导致的先天性早发性脊柱侧弯（CEOS）需要早期干预。对于单个半椎体，后路半椎体切除术和单节段融合术可以在对脊柱节段影响最小的情况下矫正畸形。既往研究表明，该技术安全有效，尽管大多数纳入研究的患者尚未达到骨骼成熟。由于CEOS是一种发育性疾病，只有在脊柱生长完成后才能确定最终的临床结果。因此，作者进行了一项长期随访研究，所有患者均达到骨骼成熟，以评估半椎体切除术和单节段融合术的效果。
对2007年至2017年间接受后路半椎体切除术和单节段融合术治疗的CEOS患者进行回顾性研究。在最近一次随访时，所有患者均达到骨骼成熟（Risser征≥4且年龄≥14岁），平均随访时间±标准差为10.5±2.5年。分析了人口统计学特征、冠状面和矢状面畸形矫正参数、脊柱和椎体生长参数、22项脊柱侧弯研究学会（SRS）-22评分以及并发症。
共纳入23例患者（15例男性和8例女性），平均年龄为4.8±2.0岁。术前主弯为32.3°±14.4°，术后显著降至7.3°±6.5°，随访期间矫正丢失15.4%。矢状面后凸明显改善并在最近一次随访时得以维持。3例患者术前存在冠状面失平衡，在最近一次随访时降至1例。T1-12和T1-S1的高度分别从术前的15.9±1.6cm和27.1±1.7cm增加到最近一次随访时的24.0±2.2cm和37.3±3.1cm。器械固定椎体和未器械固定椎体之间椎体高度和椎弓根间距的增加相当。在最近一次随访时，SRS-22总分是4.3±0.2。7例患者共发生10例并发症。
经过至骨骼成熟的长期随访，半椎体切除术和单节段融合术是治疗单个半椎体的一种安全有效的手术方法。畸形矫正得以良好维持，对脊柱生长没有不利影响，并取得了患者报告的可接受的临床结果。
