The results of thoracic and lumbar hemivertebrae resection by a dorsal pedicular approach in children

Design. A retrospective analysis of clinical observations. Purpose. To make a retrospective analysis of the results of resecting hemivertebrae by the dorsal approach through the root of the arch of the thoracic and lumbar localization. Materials and Methods. The data of 58 patients with the spine deformity through the leading malformation - formation disorder and asymmetric shapes of vertebral fusion at the age from 14 months to 27 years and 11 months who were treated within the period of 2012-2015. All the patients underwent interventions by the dorsal pedicular approach. All the surgical interventions were divided into three groups by fixation type depending on the extent and variant of the spine fixation: Group I - unilateral monosegmental fixation, Group II - bilateral monosegmental fixation, Group III - bilateral polysegmental fixation. The analysis criteria: deformity amount before and after the surgical treatment according to Cobb, correction percentage, the surgery duration, the volume of blood loss, the extent of instrumental fixation, bone block condition dynamically, the course of local deformity in the long-term periods (above two years), presence of complications. Results. In Group I deformity correction in the frontal and sagittal planes amounted to 67,4 % и 90 %, respectively. In Group II the correction in each of the planes was 72,8 % и 88,4 %. In Group III the correction values amounted to 71,2 % и 83 % in the frontal and sagittal planes. Complications were observed in 7 (12 %) patients, being represented by progression of the deformity in the zone of stabilization, as well as by the deformity of adjacent segments that required re-adjustments of fixation systems and using correcting vertebrotomies. Conclusion. The radical extirpation of hemivertebrae by the dorsal pedicular approach allows achieving complete correction of the deformity, as well as reduces the time of surgery, the number of the implanted elements, intraoperative blood loss and the periods of rehabilitative treatment. The performance of pedicular extirpation combined with bilateral fixation is preferable.