Abstract
Introduction
Treatment of neurological deficit and deformity because of the neglected dorsal hemivertebra is a challenging procedure. Restoration of the sagittal balance is also technically demanding because of the sharp, angular kyphotic deformity. The aim of this study is to evaluate the results of the patients treated by dorsal hemivertebra resection via posterior approach for spinal decompression and deformity correction.
Patients and Methods
A total of 11 patients (8 M and 3 F) with average age 32.1 years (range, 19–49 years) were operated via dorsal hemivertebrectomy with posterior only approach. In the surgical technique, following 2 to 3 levels above and below pedicle screw fixation, wide laminectomy was performed one level above and below the apex of the deformity and spinal canal was decompressed by removing the dorsal hemivertebra. Deformity correction included sequential gradually compression from posterior and distraction from anterior column to prevent any dural buckling. Finally, an expandable cage was placed for anterior column support and distracted while final compression applied from posterior to correct local kyphosis totally. Spinal cord monitoring was used at all stages of surgery in all patients. Sagittal and pelvic parameters were measured on pre-op and post-op standing X-rays.
Results
The mean follow-up was 27.5 months (range, 24–32 months). The mean surgical time was 6.5 hours (range, 5–9 hours), average blood loss was 3,200 mL. Pre-op average local kyphosis angle was 57.250 and improved to 9.30 with a correction rate of 83%. There was no significant improvement in other parameters. All patients with neurologic deficit (eight patients ASIA grade D, two patients ASIA grade C, and one patient ASIA grade B) had significant improvement to ASIA grade E. There were no major complications including pseudarthrosis and implant failure. Minor complications included two (18%) superficial wound problems and one (9%) hematoma which responded well to debridement.
Conclusion
Posterior wide laminectomy and dorsal hemivertebra resection provide decompression of the neural structures. Correction of the local kyphosis and restoring sagittal balance are very challenging in sharp angular kyphosis. Ideal correction technique should include anterior column elongation with gradual posterior compression sequentially and placement of expandable cage to prevent any dural buckling.