Adult Thoracic Hemivertebra Excision Via Posterioronly Approach
Adult Thoracic Hemivertebra Excision Via Posterioronly Approach
Hemivertebrae are a common cause of congenital scoliosis. Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children. Little has been written about congenital scoliosis presenting in adulthood. Because the aging of the spine is a kyphosing process and hemivertebrae often present with a local segmental kyphotic alignment, this can become symptomatic. Excision of hemivertebrae is well established as a safe and effective procedure when treatment is required. Initially this was conducted via a combined anterior-posterior approach. Recently some authors have indicated that in the lumbar spine hemivertebra resection can safely and effectively be achieved via a single posterior transpedicular approach. The authors report two adult cases in which they performed posterior transpedicular lateral extracavitary excision of a thoracic, fully segmented hemivertebrae. Essentially complete correction of the deformity was achieved. There were no neurological complications. The patients were spared a thoracotomy and no chest tubes were required.
The location and type of vertebral anomaly can affect the severity and prognosis of congenital scoliosis. When a large deformity is present at an early age, surgical treatment is necessary. Surgical correction of congenital curves is generally more successful when high-risk curves of a smaller magnitude are treated early. In cases in which the curves manifest later in life, treatment is more challenging to the clinician.
There are a number of surgery-related options available for the management of congenital scoliosis. Historically these options have included posterior spinal fusion with or without instrumentation, anterior and posterior fusion in situ, hemiepiphysiodesis, and fusion following hemivertebra excision via combined anterior-posterior approach. In single-stage hemivertebra excision deformity correction is advantageously combined with a short-segment fusion.
Hemivertebra excision was first reported in the early 20th century. The potential for neurological injury led Leatherman and Dickson to recommend a staged sequential anterior-posterior hemivertebra resection. In subsequent reports by Bradford and Boachie-Adjei and others the authors reported the safety and efficacy of single-stage combined anterior-posterior excision. These series included children who ranged in age from 1 to greater than 10 years. Callahan and coworkers suggested that results might be improved if surgery was performed at a younger age. The purpose of this report is to present our experience with a posterior-only transpedicular lateral extracavitary hemivertebra excision in two symptomatic adults.
Hemivertebrae are a common cause of congenital scoliosis. Depending on their location and the magnitude of the resultant deformity, they may be asymptomatic or require treatment. In the past, treatment has focused on prevention of deformity progression in growing children. Little has been written about congenital scoliosis presenting in adulthood. Because the aging of the spine is a kyphosing process and hemivertebrae often present with a local segmental kyphotic alignment, this can become symptomatic. Excision of hemivertebrae is well established as a safe and effective procedure when treatment is required. Initially this was conducted via a combined anterior-posterior approach. Recently some authors have indicated that in the lumbar spine hemivertebra resection can safely and effectively be achieved via a single posterior transpedicular approach. The authors report two adult cases in which they performed posterior transpedicular lateral extracavitary excision of a thoracic, fully segmented hemivertebrae. Essentially complete correction of the deformity was achieved. There were no neurological complications. The patients were spared a thoracotomy and no chest tubes were required.
The location and type of vertebral anomaly can affect the severity and prognosis of congenital scoliosis. When a large deformity is present at an early age, surgical treatment is necessary. Surgical correction of congenital curves is generally more successful when high-risk curves of a smaller magnitude are treated early. In cases in which the curves manifest later in life, treatment is more challenging to the clinician.
There are a number of surgery-related options available for the management of congenital scoliosis. Historically these options have included posterior spinal fusion with or without instrumentation, anterior and posterior fusion in situ, hemiepiphysiodesis, and fusion following hemivertebra excision via combined anterior-posterior approach. In single-stage hemivertebra excision deformity correction is advantageously combined with a short-segment fusion.
Hemivertebra excision was first reported in the early 20th century. The potential for neurological injury led Leatherman and Dickson to recommend a staged sequential anterior-posterior hemivertebra resection. In subsequent reports by Bradford and Boachie-Adjei and others the authors reported the safety and efficacy of single-stage combined anterior-posterior excision. These series included children who ranged in age from 1 to greater than 10 years. Callahan and coworkers suggested that results might be improved if surgery was performed at a younger age. The purpose of this report is to present our experience with a posterior-only transpedicular lateral extracavitary hemivertebra excision in two symptomatic adults.
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