Abstract
OBJECTIVE: To retrospectively analyze the feasibility and efficacy of posterior hemivertebra resection without internal fixation in the treatment of congenital scoliosis in very young children. METHODS: Sixteen cases of very young children with congenital scoliosis treated at our hospital from April 2000 to July 2019 were collected, including 8 cases of each sex, all of whom had type I/III congenital scoliosis and were operated on at a median (interquartile range) of 9.00 (7.75) months (range, 0.5-48 months) of age. All cases underwent posterior hemivertebra resection without internal fixation and wore orthopedic braces or plaster undershirts for more than six months after surgery, with a mean follow-up of 94.31 ± 65.63 months (range, 36-222 months). RESULTS: Coronal plane: the preoperative Cobb angle for the segmental curve was 39.50 ± 9.70° compared to postoperative (19.19 ± 8.56°) and last follow-up (14.94 ± 12.11°) (both P < 0.01); the preoperative Cobb angle for the main curve was 34.19 ± 14.34° compared to postoperative (17.00 ± 11.70°) and last follow-up (17.56 ± 16.31°) (both P < 0.01); the preoperative Cobb angle of the proximal compensated curve was 14.88 ± 9.62° compared to postoperative (7.88 ± 4.66°) and last follow-up (8.38 ± 8.36°) (both P < 0.05); and the preoperative Cobb angle of the distal compensated curve was 13.50° (10.50°) (range, 4°-30°) compared with postoperative 4.50° (9.25°) (range, -3° to 25°) and final follow-up 5.50° (9.50°) (range, -3° to 33°) (both P < 0.01). Sagittal plane: the difference in the preoperative Cobb angle was 10.00° (14.00°) (range, -31° to 41°) for segmental kyphosis compared to postoperative 14.00° (24.50°) (range, -6° to 46°) and last follow-up 17.00° (22.55°) (range, -40° to 56°), and these were not statistically significant (both P > 0.05). There was a tendency for the thoracolumbar kyphosis to worsen and the lumbosacral kyphosis to improve during the follow-up period. CONCLUSION: Posterior hemivertebra resection without internal fixation is a feasible treatment for type I/III congenital scoliosis in very young children, but the correction of the sagittal deformity of the thoracolumbar spine is not satisfactory, and postoperative external fixation may require further improvement.