Surgical treatment of congenital scoliosis and kyphosis due to hemivertebrae. A retrospective analysis of 53 cases

Aim of the study: We performed a retrospektive analysis of the results of o perative treatment of 53 patients with congenital scoliosis (n = 47) or kyp hosis (n = 6) due to hemivertebrae. Patients and Methods The mean age of th e patients (31 girls and 22 boys) at the time of the initial examination wa s 6+/-4 years. Surgical treatment was carried out on average at the age of 9+/-5 years. Follow-up examinations were carried out up to a mean age of 16 +/-6 years. Results: The results of operative treatment depended on the loc alization of the hemivertebrae and the surgical technique. Progression of s coliosis due to a thoracic hemivertebra was halted, but the scoliosis could not be corrected (Cobb angle at initial examination 37+/-17 degrees at fol low-up 34+/-23 degrees). Scoliosis due to lumbar hemivertebrae was reduced by surgery (Cobb angle at initial examination 36+/-14 degrees, at follow-up 21+/-15 degrees). Surgery without instrumentation led to worse results tha n did surgery with instrumentation with thoracic as well as lumbar scoliosi s. Combined dorsoventral procedures with resection of the hemivertebra seem ed to be superior to spondylodesis without resection of the hemivertebra. S urgical correction of kyphosis associated with dorsal hemivertebrae was per formed by means of dorsal or dorsoventral spondylodesis with hemivertebra r esection (preoperative kyphosis 70+/-34 degrees, at follow-up 44+/-25 degre es). Conclusion: Spondylodesis without instrumentation is associated with a n unsure prognosis with respect to effects on the progression of the scolio sis, even if it is performed on very young patients. In contrast, spondylod esis with instrumentation can achieve better and longer-lasting corrections of scoliosis even with larger initial curvatures. Scoliosis due to lumbar hemivertebrae is more amenable to surgical correction than thoracic scolios is due to hemivertebrae.