Intraoperative 3D navigation-assisted fusionless posterior transpedicular instrumentation and hemivertebra resection in congenital scoliosis: a retrospective review with a mean follow-up of 9 years

Chi-Yung Yeung ； Chi-Kuang Feng ； Chi-Chun Chu ； Ying-Chou Hsieh ； Jan-Wei Chiu ； Tsui-Fen Yang ； Jaw-Lin Wang

《Formosan Journal of Musculoskeletal Disorders》 13卷1期 (2022/02) Pp. 1-10

https://doi.org/10.6492/FJMD.202202_13(1).0001

摘要

Introduction: More than three-fourths of cases of congenital scoliosis progress significantly and require early surgical interventions. The current gold standard treatment is hemivertebra resection with short-level posterior spinal fusion, but the outcomes of fusionless surgery are rarely documented. In addition, screw malpositions were frequently reported in pediatric patients due to the small pedicle size and complex deformity. Purposes: We aimed to evaluate the mid- to long-term clinical outcomes in children aged ＜ 5 years who underwent fusionless posterior transpedicular instrumentation and hemivertebra resection assisted by intraoperative 3D navigation. Methods: This study included patients aged ＜ 5 years with single-level congenital scoliosis, with fully segmented thoracolumbar hemivertebra and Cobb angle ≥ 40° who underwent one-stage posterior-only fusionless hemivertebra resection and short-segment posterior transpedicular instrumentation under the assistance of 3D navigation system and were followed up for ≥ 5 years. Radiologic and clinical outcomes were comprehensively analysed. Results: Four consecutive patients (1 male, 3 females) were enrolled in this study. The average perioperative age of the patients was 2.2 years. Two, one, and one hemivertebra were located at the T11, T12, and L1 levels, respectively, all with left-sided scoliotic curve convexities. The instrumentation level was two vertebrae adjacent to the resected hemivertebra. A total of 16 pedicle screws were inserted using the navigation system. There were no pedicle perforations or screw-related complications. The mean follow-up period was 9.1 years. The mean correction rates of the main curve in the immediate postoperative period and at 2, 5, 7 and 10 years follow-up were 55%, 65%, 71%, 68%, and 78%, respectively, with no observed major complications or curve progression. Conclusions: Based on the mid- to long-term outcomes, 3D navigation-assisted fusionless posterior transpedicular instrumentation with hemivertebra resection is safe, feasible, and has the potential to be adopted in future clinical practice. Levels of Evidence: level III, retrospective cohort Study, therapeutic Study.

關鍵字

3D navigation ； congenital scoliosis ； fusionless ； hemivertebra resection