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

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

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The outcomes of congenital scoliosis (CS) patients undergoing hemivertebra (HV) resection surgery with a 2-level fusion versus a >2-level fusion are unclear. We hypothesized that CS patients undergoing HV resection and a >2-level fusion have decreased curve progression and reoperation rates compared with 2-level fusions. Methods: Retrospective review of prospectively collected data from a multicenter scoliosis database. Fifty-three CS patients (average age 4.5, range 1.2 to 10.9 y) at index surgery were included. Radiographic and surgical parameters, complications, as well as revision surgery rates were tracked at a minimum of 2-year follow-up. Results: Twenty-six patients had a 2-level fusion while 27 patients had a >2-level fusion with similar age and body mass index between groups. The HV was located in the lumbar spine for 69% (18/26) 2-level fusions and 30% (8/27) >2-level fusions (P=0.006). Segmental HV scoliosis curve was smaller in 2-level fusions compared to >2-level fusions preoperatively (38 vs. 50 degrees, P=0.016) and at follow-up (25 vs. 34 degrees, P=0.038). Preoperative T2-T12 (28 vs. 41 degrees, P=0.013) and segmental kyphosis (11 vs. 23 degrees, P=0.046) were smaller in 2-level fusions, but did not differ significantly at postoperative follow-up (32 vs. 39 degrees, P=0.22; 13 vs. 11 degrees, P=0.64, respectively). Furthermore, the 2 groups did not significantly differ in terms of surgical complications (27% vs. 22%, P=0.69; 2-level fusion vs. >2-level fusion, respectively), unplanned revision surgery rate (23% vs. 22%, 0.94), growing rod placement or extension of spinal fusion (15% vs. 15%, P=0.95), or health-related quality of life per the EOS-Questionnaire 24 (EOSQ-24). Comparison of patients with or without the need for growing rod placement or posterior spinal fusion revealed no significant differences in all parameters analyzed. Conclusions: Two-level and >2-level fusions can control congenital curves successfully. No differences existed in curve correction, proximal junctional kyphosis or complications between short and long-level fusion after HV resection. Both short and long level fusions are viable options and generate similar risk of revision. The decision should be individualized by patient and surgeon.

Original languageEnglish (US)
Pages (from-to)354-360
Number of pages7
JournalJournal of Pediatric Orthopaedics
Volume42
Issue number7
DOIs
StatePublished - Aug 1 2022

Keywords

  • congenital scoliosis
  • early onset scoliosis
  • hemivertebra
  • hemivertebra resection
  • posterior spinal fusion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Orthopedics and Sports Medicine

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