Liu Haonan,Li Duoyi,Guo Dong,et al.Imaging characteristics and surgical strategies for symmetrical hemivertebrae of thoracic and lumbar spine in children[J].Journal of Clinical Pediatric Surgery,,():837-841.[doi:10.3760/cma.j.cn101785-202502043]
Imaging characteristics and surgical strategies for symmetrical hemivertebrae of thoracic and lumbar spine in children
- Keywords:
- Child; Spinal Deformities; Hemivertebrae; Imaging; Surgery
- Abstract:
- Objective To analyze the imaging characteristics of symmetric thoracolumbar hemivertebrae deformity in children and summarize the individualized surgical strategies.Methods Retrospective review was conducted for the relevant clinical data of 19 children (7 boys and 12 girls) with symmetric thoracolumbar hermivertebrae deformity who were admitted to Beijing Children’s Hospital,Capital Medical University.The average age was 3.1 years.The coronal and sagittal spinal parameters were measured by long-cassette spinal radiographs.The classification of hemivertebrae and concurrent deformities were identified by computed tomography (CT) and magnetic resonance imaging (MRI).Posterior hemivertebrae resection and fusion with pedicle screw fixation were performed.The perioperative spinal parameters were re-measured at postoperative 3 month follow up and the final follow up,and the differences in radiographic parameters between preoperative and postoperative time point were compared to assess the clinical outcomes.Results A total of 38 hemivertebrae were observed.There were fully segmented type (50%) and semi-segmented type (44.7%).Unison types (89.5%) were significantly more common than discordant types (10.5%).Thoracolumbar region (T10-L2) had the highest incidence of hemivertebrae (60.5%).Hemivertebraes were separated by a mean of 4 normal vertebrae.The most common distribution type of hemivertebrae was T10-T12 + L1-L3 (42.1%).The proximal compensatory curve was significantly greater than the distal compensatory curve.Sacral slanting occurred (n=13,68.4%).Most of them had a significantly elevated thoracolumbar kyphosis with an average of (14.7± 13.6)°.CT/MRI confirmed that 3 cases (15.8%) had concurrent deformities.Fourteen children (73.6%) were operated once while another 5(26.3%) twice.At the final follow-up,the correction rate of segmental scoliosis was 84.4%.The proximal compensatory curve dropped from (12.0±6.7)° to (6.1±4.5)° (P= 0.001),distal compensatory curve from (9.1±7.0)° to (5.6±4.1)° (P=0.031),C7-CVSL from (14.8±14.3) to (8.2±4.9) mm (P=0.034) and thoracolumbar kyphosis from (14.7±13.7)° to (7.6±5.2)° (P=0.033).Although sacral slanting,lumbar lordosis and thoracic kyphosis were improved compared with preoperative values,there were no statistically significant differences (P>0.05).Conclusions The symmetric thoracolumbar hemivertebrae deformity is relatively complex.And hemivertebrae are predominant in thoracolumbar region.Hemivertebrae resection is an effective surgical approach.Individualized treatment should be formulated on the basis of such factors as location and interval segments of hemivertebrae.
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Memo
收稿日期:2025-2-21。
基金项目:国家重点研发计划（2023YFC2507703）
通讯作者:郭东,Email:dr.guodong@vip.163.com