Pediatric Spine Foundation

Title: Posterior-only Resection of Single Hemivertebrae With 2-Level Versus >2-Level Fusion: Can We Improve Outcomes?

Authors: Jaime A. Gomez, David H. Ge, Emma Boden, Regina Hanstein, Leila Mehraban Alvandi, Yungtai Lo, Steven Hwang, Amer F. Samdani, Paul D. Sponseller, Sumeet Garg, David L. Skaggs, Michael G. Vitale, John Emans, Pediatric Spine Study Group

Journal: J Pediatr Orthop

Date: January 01, 2022

Excerpt: Both short and long level fusions are viable options and generate similar risk of revision. The decision should be individualized by patient and surgeon.

Keywords: hemivertebra, early onset scoliosis, congenital scoliosis, hemivertebra resection, posterior spinal fusion

Summary:

Purpose

This study reviewed how congenital scoliosis patients did after surgery for the removal of a hemivertebra (HV) along with a 2-level or >2-level fusion surgery. Using data from 53 children with congenital scoliosis who had surgery to remove a hemivertebra and had a spinal fusion surgery. The study compares the two fusion methods in controlling the spinal curve and lowering the need for reoperation.

Results

  • The scoliosis curve was smaller in 2-level fusions compared to > 2-level fusions before surgery (38 vs. 50 degrees) and at follow-up after surgery (25 vs. 34 degrees).
  • Spine height before surgery and segmental kyphosis curves (11 vs. 23 degrees) were smaller in 2- level fusions, but did not differ enough after surgery to be noteworthy (32 vs. 39 degrees; 13 vs. 11 degrees).
  • The 2 groups did not have a noteworthy difference in terms of surgical complications (27% vs. 22%, 2-level fusion vs. >2-level fusion), unplanned revision surgery rate (23% vs. 22%), growing rod placement or making the spinal fusion longer (15% vs. 15%), or health-related quality of life per the EOS-Questionnaire 24 (EOSQ-24).

Discussion Points

  • Both 2-level and >2-level fusions were successful in controlling the spinal curves and making the patient's condition better. There was not a noteworthy difference in curve correction, the occurrence of issues after surgery, the need for further surgeries, or the patients' quality of life between the two methods.
  • Both 2-level and >2-level fusions are reasonable options to treat congenital scoliosis, with similar things that can cause issues. As a result, the decision for which type of fusion to choose for a patient should be based on individualized factors such as curve severity and patient conditions.