540 - Convex Short Segment Instrumentation and Hemi-chevron Osteotomies for...

#540 Convex Short Segment Instrumentation and Hemi-chevron Osteotomies for Putti Type 1 Thoracic Hemivertebrae: A Simple Treatment Option for Patients under 5 Years Old

Pediatric Spine

Poster Presented by: K.C. Kose

Author(s):

K.C. Kose (1)
M.E. Inanmaz (1)
L. Altınel (2)
E. Bal (1)
I. Caliskan (1)
C. Isik (3)
V. Ergan (1)

(1) Sakarya University, Adapazari, Turkey
(2) Akdeniz University, Antalya, Turkey
(3) Bolu Izzet Baysal University, Bolu, Turkey

Abstract

Objective: To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.

Summary of background data:Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.

Methods: Twelve patients < 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunkshift were measured both preoperatively and postoperatively.

Results: The mean correction of the segmental curve was 6,31° (21%) which was maintained at the latest follow-up. The average final correction of the main curve was %22.79.

The trunk shift was 1.83cm (range, 1-3cm) preoperative and 1.41cm (range, 0-2.5cm) at the latest follow-up.

The segmental angle of kyphosis averaged 10,91° (range, -12-20°) preoperative, and 14,25° (range, 0-29°) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5° (range, 10-46°) preoperative, 30.91° (range, 10-44°) postoperative, and 31,75° (range, 16-45°) at the last follow-up resulting in a mean improvement of 1.89°. This improvement continued at the latest follow-up with a mean increase of 3.34°.

Conclusions: Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well-tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves.