What is the indication for hemivertebra excision

Hemivertebra excision is indicated for a fully segmented hemivertebra, causing significant trunk imbalance (Fig. 42-3). This is theoretically a more dangerous procedure than in situ fusion or hemiepiphyseodesis. However, it produces dramatic curve correction while maintaining maximal spinal flexibility. It is the treatment of choice for a lumbosacral hemivertebra, causing significant oblique take-off. A number of surgical series using a simultaneous anterior and posterior approach for hemivertebra excision have documented excellent results with few complications. More recently, posterior-only techniques have been advocated as an alternative technique.

Figure 42-3. A and B, This 2-year-old boy with scoliosis, secondary to a fully segmented hemivertebra, progressed 12° in 1 year. C and D, A hemivertebra resection performed through a single-stage posterior approach produced a significant improvement in both the curvature and coronal balance without an appreciable loss of flexibility or growth. In a small child, the bones may not tolerate the stresses produced by instrumented manipulation, and fixation to maintain the correction may be lost. Here the correction was obtained by manual pressure over the ribs and flank and compression of the laminar hooks. The correction was then fine-tuned and maintained by the pedicle screw-rod construct.

Figure 42-3. A and B, This 2-year-old boy with scoliosis, secondary to a fully segmented hemivertebra, progressed 12° in 1 year. C and D, A hemivertebra resection performed through a single-stage posterior approach produced a significant improvement in both the curvature and coronal balance without an appreciable loss of flexibility or growth. In a small child, the bones may not tolerate the stresses produced by instrumented manipulation, and fixation to maintain the correction may be lost. Here the correction was obtained by manual pressure over the ribs and flank and compression of the laminar hooks. The correction was then fine-tuned and maintained by the pedicle screw-rod construct.

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