Date of Presentation
5-2-2024 12:00 AM
College
Rowan-Virtua School of Osteopathic Medicine
Poster Abstract
Introduction:
Hemivertebrae are rare congenital anomalies that can cause severe scoliosis requiring surgical correction. We aimed to determine whether severity of deformities is associated with more long-term surgical complications following surgical correction.
Methods:
We performed a retrospective, single-institution review on patients who underwent hemivertebrectomy and spinal fusion for congenital scoliosis between 2008-2020. We extracted pertinent data on demographics, radiographic parameters, operative details, and complication rates. Subgroup analyses were also done by complication severity, deformity complexity, and construct length.
Results:
In our series, 30 patients underwent hemivertebrectomy and fusion. Mean age was 9±4.2 years and there was 2:1 male preponderance, with median follow-up of 74.5 months. 43% of patients had complex deformities, defined as ≥3 bony abnormalities on X-ray. In cases of multiple hemivertebrae (n=2), only the dominant lesion was excised. Half the patients underwent long segment fixation (>5 levels), which were chosen for larger deformities, and resulted in similar coronal and sagittal balance to shorter constructs. Mean EBL was 533.7±502.0 mL. Three patients had intraoperative neuromonitoring changes, which subsequently improved with minimal or no long-term deficits. Surgical correction improved the major coronal Cobb angle and deformity angular ratio (both p<0.01) at both first and last follow-up. In the short-term, there were 5 complications: pneumothorax (n=2), retained surgical drain requiring takeback (n=1), postop pneumonia (n=1), and T12 nerve root avulsion (n=1). There were 2 long-term complications requiring revision surgery: displaced and prominent hardware, and pseudarthrosis with wound dehiscence. Three other patients showed evidence of disease progression, and two of them underwent revision fusions. On subgroup analysis comparing complications vs no complications, construct length, and deformity complexity, no significant differences in demographics, surgical planning, or outcomes were found.
Conclusions:
Surgical and long-term complication rates were 17% and 7%, respectively. While no specific risk factors for complications were found in our cohort, hemivertebrectomy resection and correction of congenital scoliosis should be approached with caution and careful planning.
Keywords
Congenital scoliosis, Scoliosis, Hemivertebrae, Spine, Postoperative Complications, Retrospective chart review, Retrospective Studies, Spinal Fusion
Disciplines
Congenital, Hereditary, and Neonatal Diseases and Abnormalities | Medicine and Health Sciences | Musculoskeletal Diseases | Musculoskeletal System | Orthopedics | Pathological Conditions, Signs and Symptoms | Pediatrics | Surgery | Surgical Procedures, Operative | Therapeutics
Document Type
Poster
Included in
Congenital, Hereditary, and Neonatal Diseases and Abnormalities Commons, Musculoskeletal Diseases Commons, Musculoskeletal System Commons, Orthopedics Commons, Pathological Conditions, Signs and Symptoms Commons, Pediatrics Commons, Surgery Commons, Surgical Procedures, Operative Commons, Therapeutics Commons
Complications Following Hemivertebrectomy for Congenital Scoliosis
Introduction:
Hemivertebrae are rare congenital anomalies that can cause severe scoliosis requiring surgical correction. We aimed to determine whether severity of deformities is associated with more long-term surgical complications following surgical correction.
Methods:
We performed a retrospective, single-institution review on patients who underwent hemivertebrectomy and spinal fusion for congenital scoliosis between 2008-2020. We extracted pertinent data on demographics, radiographic parameters, operative details, and complication rates. Subgroup analyses were also done by complication severity, deformity complexity, and construct length.
Results:
In our series, 30 patients underwent hemivertebrectomy and fusion. Mean age was 9±4.2 years and there was 2:1 male preponderance, with median follow-up of 74.5 months. 43% of patients had complex deformities, defined as ≥3 bony abnormalities on X-ray. In cases of multiple hemivertebrae (n=2), only the dominant lesion was excised. Half the patients underwent long segment fixation (>5 levels), which were chosen for larger deformities, and resulted in similar coronal and sagittal balance to shorter constructs. Mean EBL was 533.7±502.0 mL. Three patients had intraoperative neuromonitoring changes, which subsequently improved with minimal or no long-term deficits. Surgical correction improved the major coronal Cobb angle and deformity angular ratio (both p<0.01) at both first and last follow-up. In the short-term, there were 5 complications: pneumothorax (n=2), retained surgical drain requiring takeback (n=1), postop pneumonia (n=1), and T12 nerve root avulsion (n=1). There were 2 long-term complications requiring revision surgery: displaced and prominent hardware, and pseudarthrosis with wound dehiscence. Three other patients showed evidence of disease progression, and two of them underwent revision fusions. On subgroup analysis comparing complications vs no complications, construct length, and deformity complexity, no significant differences in demographics, surgical planning, or outcomes were found.
Conclusions:
Surgical and long-term complication rates were 17% and 7%, respectively. While no specific risk factors for complications were found in our cohort, hemivertebrectomy resection and correction of congenital scoliosis should be approached with caution and careful planning.