Introduction: A single lumbar hemivertebra can result in a progressive spinal deformity with devastating consequences. Total resection of these hemivertebrae is ideal for correcting these deformities and several alternatives were suggested including anterior and/or posterior approaches. The aim of this study is to evaluate the clinical and radiographic outcome of single stage vertebral column resection (VCR) in children less than 10 years old.
Methods: The study was performed between 2000 and 2008 and included 31 patients with a lumbar hemivertebra. The average age was 8 years (range, 6 - 9.5 years). VCR involved laminectomy, excision of the pedicle and hemivertebra, and curettage of both end plates; the gap created was filled with morselized cancellous bone. Short segment posterior instrumentation was performed; the gap was gently closed by compression over the pedicle screws and the remaining autograft bone was placed in the posterolateral gutter.
Results: Patients were followed-up for an average of 5.5 years (range 2 – 8 years). The operative time had an average of 235 min (range, 200 – 275 minutes) and the average blood loss was 470 cc (range, 230 - 830 cc). The scoliotic deformity corrected from an average of 43° to an average of 4° postoperatively and an average of 6° at final follow up; kyphosis corrected from an average of 34° to an average of 5° postoperatively and an average of 7° at final follow up. There were no vascular injuries, neurologic insult, implant failure or crank shafting.
Conclusion: Single stage posterior VCR with short segment pedicle screw instrumentation is a safe, efficient alternative that offers excellent correction in both sagittal and coronal planes without the need for anterior surgery.