Convex Short Segment Instrumentation And Hemi-chevron Osteotomies For Putti Type 1 Thoracic Hemivertebrae: A Simple Treatment Option For Patients Under 5 Years Old

Presented at SMISS Annual Forum 2014
By Kamil Kose Prof Dr
With Mustafa Inanmaz , Levent Altinel , Emre Bal , Islam Caliskan , Cengiz Isik , Volkan Ergan ,

Disclosures: Kamil Kose Prof Dr None Mustafa Inanmaz None, Levent Altinel None, Emre Bal None, Islam Caliskan None, Cengiz Isik None, Volkan Ergan None,

Introduction:
This is a case series depicting the results of a novel surgical technique.

SUMMARY OF BACKGROUND DATA:
Congenital hemivertebrae have been treated by anterior and posterior growth arrest with/without fusion, anterior and posterior hemivertebrectomy, transpedicular hemivertebra excision, and transpedicular hemiepiphysiodesis. These approaches are complex and require experience. There is a need for a simple treatment method to treat these deformities.

Aims/Objectives:
To prove that a minimally invasive surgical technique can effectively control and even correct congenital scoliosis caused by a fully segmented hemivertebra.

Methods:
Twelve patients under 5 years of age with Putti type1 hemivertebrae were treated by posterior convex short segment instrumentation, partial chevron osteotomies, and fusion. Scoliosis, segmental scoliosis, kyphosis, segmental kyphosis, trunk shift were measured both preoperatively and postoperatively.

Results:
The mean correction of the segmental curve was 6 degrees (21%) which was maintained at the latest follow-up. The average final correction of the main curve was 23%. The trunk shift was 1.8 cm (range, 1-3 cm) preoperative and 1.4 cm (range, 0-2.5 cm) at the latest follow-up. The segmental angle of kyphosis averaged 11 degrees (range, -12 to 20 degrees) preoperative, and 14 degrees (range, 0-29 degrees) at the latest follow-up assessment. The values of the total thoracic kyphosis (T2-T12) were 29.5 degrees (range, 10-46 degrees) preoperative, 31 degrees (range, 10-44 degrees) postoperative, and 32 degrees (range, 16-45 degrees) at the last follow-up resulting in a mean improvement of 2 degrees. This improvement continued at the latest follow-up with a mean increase of 3 degrees.

Conclusions:
Transpedicular instrumentation is ideal for early correction in young children. The new posterior approach is much less invasive than the combined approaches or other posterior vertebrectomies and is well tolerated even in very young patients. The fusion segment is kept short. The deformities seem to stop progressing and this can avoid development of severe local deformities and secondary curves.