Resection of congenital hemivertebra in pediatric scoliosis: the experience of a two-specialty surgical team

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  • 1 Department of Orthopedics, Columbia University Irving Medical Center, New York, New York;
  • | 2 USA Health, Mobile, Alabama; and
  • | 3 Neurosurgeons of New Jersey, Ridgewood, New Jersey
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OBJECTIVE

Institutions investigating value and quality emphasize utilization of two attending surgeons with different areas of technical expertise to treat complex surgical cases and to minimize complications. Here, the authors chronicle the 12-year experience of using a two–attending surgeon, two-specialty model to perform hemivertebra resection in the pediatric population.

METHODS

Retrospective cohort data from 2008 to 2019 were obtained from the NewYork-Presbyterian Morgan Stanley Children’s Hospital operative database. This database included all consecutive pediatric patients < 21 years old who underwent hemivertebra resection performed with the two–attending surgeon (neurosurgeon and orthopedic surgeon) model. Demographic information was extracted. Intraoperative complications, including durotomy and direct neurological injury, were queried from the clinical records. Intraoperative neuromonitoring data were evaluated. Postoperative complications were queried, and length of follow-up was determined from the clinical records.

RESULTS

From 2008 to 2019, 22 patients with a median (range) age of 9.1 (2.0–19.3) years underwent hemivertebra resection with the two–attending surgeon, two-specialty model. The median (range) number of levels fused was 2 (0–16). The mean (range) operative time was 5 hours and 14 minutes (2 hours and 59 minutes to 8 hours and 30 minutes), and the median (range) estimated blood loss was 325 (80–2700) ml. Navigation was used in 14% (n = 3) of patients. Neither Gardner-Wells tongs nor halo traction was used in any operation. Neuromonitoring signals significantly decreased or were lost in 14% (n = 3) of patients. At a mean ± SD (range) follow-up of 4.6 ± 3.4 (1.0–11.6) years, 31% (n = 7) of patients had a postoperative complication, including 2 instances of proximal junctional kyphosis, 2 instances of distal junctional kyphosis, 2 wound complications, 1 instance of pseudoarthrosis with hardware failure, and 1 instance of screw pullout. The return to the operating room (OR) rate was 27% (n = 6), which included patients with the abovementioned wound complications, distal junctional kyphosis, pseudoarthrosis, and screw pullout, as well as a patient who required spinal fusion after loss of motor evoked potentials during index surgery.

CONCLUSIONS

Twenty-two patients underwent hemivertebra resection with a two–attending surgeon, two-specialty model over a 12-year period at a specialized children’s hospital, with a 14% rate of change in neuromonitoring, 32% rate of nonneurological complications, and a 27% rate of unplanned return to the OR.

ABBREVIATIONS

DJK = distal junctional kyphosis; EBL = estimated blood loss; HV = hemivertebra; MEP = motor evoked potential; OR = operating room; OT = operative time; PJK = proximal junctional kyphosis; PSIF = posterior spinal instrumentation and fusion; UIV = upper instrumented vertebra.

Supplementary Materials

    • Supplemental Tables 1 and 2 (PDF 499 KB)

Illustration from Seaman et al. (pp 260–267). Copyright Jane Whitney. Published with permission.

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Contributor Notes

Correspondence Elise C. Bixby: Columbia University Irving Medical Center, New York, NY. ecb2173@cumc.columbia.edu.

INCLUDE WHEN CITING Published online July 2, 2021; DOI: 10.3171/2020.12.PEDS20783.

Disclosures Dr. Vitale is a paid consultant for Zimmer Biomet and Stryker; receives intellectual property royalties from Zimmer Biomet; receives other financial or material support from the FOX Children’s Spine Foundation; receives research support from the Children’s Spine Foundation, Orthopaedic Research and Education Foundation, Scoliosis Research Society, Pediatric Orthopaedic Society of North America (POSNA), and Orthopaedic Science and Research Foundation; and is a board or committee member of the Children’s Spine Foundation, the International Pediatric Orthopaedic Symposium, POSNA, and the Project for Safety in Spine Surgery. Dr. Anderson is a consultant for Wishbone.

ACCOMPANYING EDITORIAL DOI: 10.3171/2021.1.PEDS20955.

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