LONG-TERM RESULTS OF COMBINED ANTERIOR AND POSTERIOR CONVEX EPIPHYSIODESIS FOR CONGENITAL SCOLIOSIS DUE TO HEMIVERTEBRAE

Study Design. Retrospective review of patient records with recent clin ical and radiologic assessment. Objective. To evaluate the long-term r esult of anterior and posterior convex epiphysiodesis in the managemen t of congenital scoliosis resulting from fully segmented nonincarcerat ed hemivertebra. Summary of Background Data. Thirty patients (16 male/ 14 female patients) were reviewed. Follow-up was a minimum of 3 years (average, 8 years 10 months; range, 3-22.5 years). Nineteen patients w ere skeletally mature, and the mean age of the remaining 11 was 11.75 years. Method. Clinical evaluation and sequential measurements of Cobb angle was made independently by two observers. Results. Compared with preoperative values, the rate of change in Cobb angle was reversed in 23 patients, arrested or slowed in five patients, and unchanged or pr ogressed in two patients. The annual rate of change in Cobb angle was +1.9 degrees before surgery and -1.2 degrees after surgery, a differen ce of 3.1 degrees. This is highly statistically significant (P < 0.001 ). Total correction in Cobb angle correlates with age at time of surge ry (P < 0.03). The rate of correction in Cobb angle after surgery corr elates with the total correction achieved (P < 0.001) and with age at time of surgery (P < 0.05). The greater correction is achieved when su rgery is performed at a young age. The preoperative rate of increase i n Cobb angle does not correlate with correction (P < 0.76). The site o f the hemivertebrae influenced final outcome with best results in the lumbar spine. Conclusion. Combined anterior and posterior convex epiph ysiodesis is a reliable method for the correction of deformity resulti ng from hemivertebrae.