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Thread: Hemivertibrae resection

  1. #1
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    Hemivertibrae resection

    What is the success rate for this surgery? There's anterior and posterior surgery for this, I understand. Which is more successful? Is anterior only used for a tether? Is posterior performed for fusion only?

    What are the long term effects of fusion or a tether?

  2. #2
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    I hope others reply also but here is what I think is the case.

    Quote Originally Posted by EL-34 View Post
    What is the success rate for this surgery?
    I suspect every case is different so there may be no answer to this question. All you can do is pick an experienced surgeon. They take patients as they come and the outcome is probably much more driven by the patient than the surgeon if you are dealing with an experienced person. Thus the best most experienced surgeons often take the most difficult cases and may have the most malpractice suits because they take the worst cases. I just want you to be aware of this.

    There's anterior and posterior surgery for this, I understand. Which is more successful?
    The surgeon makes this call based on their preference. If you have a preference pick your surgeon accordingly. That said, I have to wonder if there is a range of opinion on classes of hemi-vertebrae. It may be they usually do one or the other depending on where it is in the spine.

    Is anterior only used for a tether? Is posterior performed for fusion only?
    I am not aware of tethers being used for congenital. Maybe so but maybe not. In re posterior procedures, fusion is definitely done that way in addition to anteriorly. In re tethering, I think the first approved use for lumbar was posteriorly and not associated with scoliosis but I could be wrong. Nowadays it is also approved for growing children with scoliosis as an anterior procedure.

    What are the long term effects of fusion or a tether?
    The long term effects of modern instrumentation for fusion is coming into view for AIS. I am not sure there are long term, large scale studies for congenital but there may be. There is no long term for tethering for AIS with any reasonable sample size. And again, I am not aware tethering is done with congenital so there may be nothing long or short term on that.
    Last edited by Pooka1; 11-25-2019 at 07:27 AM.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  3. #3
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    This is a closed Facebook group on tethering. You have to ask to join. (I am not on it.) They will know if some surgeon is tethering congenital cases.

    https://www.facebook.com/groups/1121136701231861/
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  4. #4
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    Here is a relatively recent review article on the long term for congenital treatments

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3120793/

    Scoliosis. 2011; 6: 12.
    Published online 2011 Jun 4. doi: 10.1186/1748-7161-6-12
    PMCID: PMC3120793
    PMID: 21639924

    Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

    Angelos Kaspiris,corresponding author1 Theodoros B Grivas,2 Hans-Rudolf Weiss,3 and Deborah Turnbull4


    Abstract

    Background
    In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis.

    Methods
    Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life.

    Results
    A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied.

    Discussion
    Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children.

    Conclusions
    Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment.

    In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor- pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary.
    Sharon, mother of identical twin girls with scoliosis

    No island of sanity.

    Question: What do you call alternative medicine that works?
    Answer: Medicine


    "We are all African."

  5. #5
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    Quote Originally Posted by EL-34 View Post
    What is the success rate for this surgery? There's anterior and posterior surgery for this, I understand. Which is more successful? Is anterior only used for a tether? Is posterior performed for fusion only?

    What are the long term effects of fusion or a tether?
    Hi...

    As far as I know, there are no deformity surgeons who participate in this forum, so it's unlikely that you'll get any answers that help you decide what's best in your son's situation. What's right for one child might be completely inappropriate for the next.

    I strongly recommend that you find a surgeon you feel you can trust, and then allow them to do what they feel is best.

    Have you gotten a second opinion?

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

  6. #6
    Join Date
    Sep 2003
    Location
    Northern California
    Posts
    7,125
    Hi...

    Are you in Canada? If so, what territory?

    --Linda
    Never argue with an idiot. They always drag you down to their level, and then they beat you with experience. --Twain
    ---------------------------------------------------------------------------------------------------------------------------------------------------
    Surgery 2/10/93 A/P fusion T4-L3
    Surgery 1/20/11 A/P fusion L2-sacrum w/pelvic fixation

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