SURGICAL TREATMENT OF CHILDREN WITH CONGENITAL LUMBAR SCOLIOSIS: COMPLETE OR PARTIAL RESECTION OF MALFORMED VERTEBRAE?

Abstract

The purpose of the study – to compare the effectiveness of surgical correction of spine lumbar congenital deformity by complete or partial resection of the abnormal vertebra in children.Material and methods. 68 children with isolated congenital malformation of the lumbar area of the spine were evaluated both clinically and instrumentally. Age of the patients was 6 months — 16 years 2 months (mean — 4 years 5 months). There were 41 female and 27 male patients. Patients were divided in two groups depending on the volume of the surgery. First group (n = 52) consisted of patients treated with complete hemivertebrae resection. Second group (n = 16) consisted of patients treated with partial resection of the malformed vertebrae.Results. After the surgery in the 1st group scoliotic curve was 0 to 21° and kyphotic curve was from -33 to 9°. 9 years post-op scoliotic and kyphotic curves were 0 to 22° and -31 to 10° respectively. In the 2nd group scoliotic curve was 3 to 27° and kyphotic curve was from -30 to 12°. 9 years post-op scoliotic and kyphotic curves were 7 to 41° and -26 to 8° respectively. Significant differences in the amount of scoliotic curve correction were revealed between the groups: in the 1st group mean Cobb angle for the scoliotic curve after surgery was 3,3° (correction — 94%), in the 2nd group — 13,6° (correction — 80%) (p<0,05). Mean Cobb angle for the scoliotic curve in the long-term period was 5° (correction — 92%) for the 1st group wich was significantly lower (p<0,05) comparing to the 2nd group (mean Cobb angle 18,3° correction — 62%).Conclusion. Our data showed higher efficacy of the complete resection of the hemivertebrae comparing to its partial resection in pediatric patients with isolated malformation in the lumbar spine. Complete removal of the vertebrae body, its growth plates and disks allowed to achieve radical correction of the deformity and to perform short fusion of the adjacent segments which was crucial for further normal growth and development of the child’s spine with saving the results in the long-term period. Thus complete resection of the malformed vertebrae with radical correction and short segment fusion is the most appropriate option in surgical treatment of pediatric patient of any age with isolated vertebrae malformation in the lumbar spine.

Keywords

• congenital scoliosis, hemivertebrae extirpation, hemivertebrae partial resection