The efficacy of posterior hemivertebra resection with lumbosacral fixation and fusion in the treatment of congenital scoliosis: A more than 2-year follow-up study

Hemivertebrae (HV) located at the lower lumbar or lumbosacral region often produce early trunk imbalance and long compensatory curves. Because of the biomechanical characteristics of the lumbosacral junction, the rate of instrumentation failures at the region has always been high. Our study aimed to evaluate the results of posterior HV resection with lumbosacral fixation and fusion in the treatment of congenital scoliosis and to make a preliminary analysis of the possible risk factors for instrument failures. From 2010 to 2015, 17 patients (7 males and 10 females) with congenital scoliosis underwent HV resection with lumbosacral fixation and fusion in our department. The mean patient age was 13.2 ± 4.4 years at surgery, and the mean follow-up time was 37.6 ± 4.6 months. Clinical outcomes and related complications were assessed by reviewing medical records, operative notes, radiographic data, and scores on the SRS-22 questionnaire. The mean Cobb angle of the segmental curve was 37.5° ± 12.7° preoperatively, 7.9° ± 5.5° postoperatively, and 7.9° ± 5.3° at the latest follow-up. The mean Cobb angle of the cranial compensatory curve was 39.2° ± 17.2°, 9.1° ± 9.5°, and 9.5° ± 10.8°, respectively. Trunk balance was improved in both the coronal (59.6%) and sagittal (58.6%) planes after surgery, and remained stable at the latest follow-up. Three domains of SRS-22, including self-image, mental health, and satisfaction, were significantly improved at the latest follow-up compared with preoperative status. Complications included one transient neurologic impairment, one superficial wound infection, and two implant failures. Early posterior HV resection with short lumbosacral fixation and fusion is effective in the treatment of HV located at lower lumbar or lumbosacral region. Delayed surgical intervention may lead to longer fusion and fixation. A long lumbosacral construct using only S1 pedicle screws as distal anchors tends to accompany a high rate of implant failures.