SIMULTANEOUS ANTERIOR AND POSTERIOR HEMIVERTEBRA RESECTION IN THE TREATMENT OF CONGENITAL KYPHOSCOLIOSIS

Objective To evaluate the efficacy of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra. Methods Twenty-one consecutive cases with congenital kyphoscoliosis, which were 8 males and 13 females, underwent one-stage operation of anterior hemivertebra resection and posterior instrumentation. All of the hemivertebra were fully-segmented. The average age at surgery was 11.4 （range, 1.5-16） years old. Results The average follow-up was 23 （range, 6-50） months. The average Cobb＇s angle of the coronal curve was 51.4° （30°-120°） before surgery, 16.9° （0°-54°） after surgery, and 19.5° at latest follow-up. The angle of segmental kyphosis was 37.1° （0°-95°） before surgery and 16.1° （0°-48°） after surgery, and 18.2° at latest follow-up. Apical translation was improved from 4.7 cm to 1.9 cm. The average fusion segments were 4.8 （range, 2-10） segments. Complication included pressure sore in one case, pedicle cutting by pedicle screw in one case and elongation of the curve in one case. There was no obvious pseudarthrosis, decompensation, and kyohosis deformity aggravation at latest follow-up. Conclusion One-stage hemivortebra resection has a good result in the surgical treatment of congenital kyphoscoliosis caused by fully-segmented hemivertebra, and may shorten fusion levels if performed at an earlier age.

VIDEO-ASSISTED THORACOSCOPIC CORRECTION AND FUSION OF SCOLIOSIS

Objective To evaluate the operative technique and preliminary results of video-assisted thoracoscopic anterior correction and fusion of scoliosis. Methods Eleven cases underwent thoracoscopic anterior correction and fusion of scoliosis from March 2003 to April 2005 in our hospital were reviewed. They were all females with an average age of 13.1 years old. Of which, 9 cases were idiopathic scoliosis, 1 case was congenital scoliosis, and 1 case was Marian syndrome scoliosis. The coronal Cobb angle and apical vertebral translation before and after surgery as well as at final follow-up were measured. The operation time, blood loss during operation, and peri-operative complications were recorded. The mean operation time was 6. 4 hours, mean instrumented vertebrae were 6.4 segments, and mean blood loss during operation was 364 mU The coronal Cobb angles of the thoracic curve before and after surgery were 45.5° and 15.4° respectively, with an average correction rate of 65.4%. The lumbar curve was corrected from 28.4° to 11.8° , with an average simultaneous correction rate of 57.2%. All of the patients were followed up regularly with an average time of 21.4 months. At the final foUow-up, the coronal Cobb angles of the thoracic and lumbar curves were 19.0° and 20. 1° , with a 3.6° and 8. 3° loss of correction, respectively. The apical vertebral translation was improved from 32. 3 mm to 10.5 mm for the thoracic curve, and from 13.1 mm to 8.2 mm for the lumbar curve. There were 6 cases with peri-opemtive complications, including 1 case of thoracic effusion, 1 case of chylothomx, 1 case of locking plug loosing, 2 cases of aggravation of the unfused lumbar curve （ 1 case also with thoracolumbar kyphosis）, and 1 case with a screw tip causing a contour deformity of the aorta. And 4 of them underwent revision surgery.Conclusions Video-assisted thoracoscopic anterior correction and fusion of scoliosis has good correction capability, less intraoperative bleeding, and favorable cosmetic effect for mild and moderate thoracic scoliosis, but with higher rates of cor- rection loss of the lumbar curve and peri-operative complications. A surgeon should be cautious to perform this technique.