Download Spinal Deformity Resulting from Hemivertebra

Spinal Deformity Resulting from Hemivertebra
D.H. is a 21 month old child who was identified with congenital spinal abnormalities at birth.
Multiple hemivertebra, three in all, were appreciated in the thoracic spine. Hemivertebra
represent a failure in formation of the vertebra, causing the spine to deviate from its otherwise
straight position. These hemivertebra were located on the left side of the spine. This creates a
significant imbalance of growth with the left side of the spine. This imbalance of growth
resulted in a progression of her scoliosis deformity noted between her birth and her second
birthday. The only available treatment option for this child’s progressive scoliosis was that of a
spinal fusion procedure. Bracing is not an effective treatment in this condition. In certain cases,
the portion of the spine which is growing too rapidly may be halted via a spinal fusion
procedure.
The fusion is performed only on the side of the spine which is growing too rapidly. This allows
the contralateral spinal tissues to continue their growth and actually can result in an
improvement of the spinal curvature already appreciated. This technique is ideally suited for
the management of progressive congenital spinal curves due to hemi-vertebra in children with
mild to moderate progressive scoliosis under age five.
At age 21 months, D.H. underwent this procedure which involved both anterior and posterior
hemi-fusion including all three of the hemi-vertebra identified. The anterior and posterior
spinal fusion procedures were performed at the same sitting. The patient tolerated these
procedures well and was discharged home within one week’s time in a small plastic brace. She
wore this brace for a total of six months until her fusion was deemed solid. She suffered no ill
effects from the surgical procedure. Over a two year period of observation, progressive
improvement in her scoliosis deformity has been appreciated presumably due to continued
growth on the right side of her spine. Her clinical appearance is superb and it is unlikely that
any further spinal surgery will be required given her early good result.
This approach to the management of progressive congenital deformities in small children has
been successfully utilized in many scoliosis centers. It involves a growth arrest on the side of the
spine which is growing too fast. This allows the slower growing spine the opportunity to catch
up. Over time, this actually results in an improvement in the scoliotic deformity. This technique
is most applicable to small children with hemi-vertebra resulting in a modest to moderate
deformity that have proven themselves to be progressive. Up until this point in time, it appears
to have worked quite successfully for this child’s spinal deformity.
*See Below for Preoperative and Postoperative X-rays*
Pre-Operative Radiographs
Close-Up View
of Hemivertebrae
Post-Operative Radiographs