Neurosurgery Resident University of North Carolina Chapel Hill, NC, US
Disclosure(s):
Aaron Gelinne, MD: No financial relationships to disclose
Introduction: Hemivertebra (HV) is a rare congenital spinal disorder, impacting approximately 1 in 1000 births. It is characterized by incomplete vertebral formation, leading to spinal deformities such as scoliosis. The asymmetric structure of HV causes biomechanical stress on adjacent vertebrae, which can accelerate spinal curvature, especially in pediatric patients. We present an illustrative and surgical video guide demonstrating a hemivertebrectomy in an adolescent with neglected lumbar scoliosis.
Methods: The patient is a 13-year-old female who presented with several years of lower back pain and coronal trunk shift. She had lived abroad for several years, and never had her spinal deformity evaluated. Scoliosis X-rays showed a 70-degree focal lumbar scoliotic curve with a congenital hemivertebra and a compensatory lower thoracic scoliotic curve. Given her age, skeletal maturity, and degree of scoliosis, we performed a short-segment L1-5 instrumented fusion with vertebral column resection of the supernumerary hemivertebra between L3 and L4.
Results: The patient had complete resolution of her back pain and returned to normal activity. Follow-up scoliosis x-rays at one-year demonstrated a significant sagittal and coronal plane correction of her prior scoliotic curve with normalized thoracic compensation. Although she continues to have pelvic obliquity, the patient experiences a significantly improved quality of life, as she is now fully engaged in school athletics.
Conclusion : This case highlights the magnitude of deformity that can accompany a neglected congenital case of scoliosis due to a supernumerary hemivertebra. The executed surgical plan was able to achieve a balance between a sufficient deformity correction and maintaining motion at the lumbosacral junction. This report provides a nuanced account of the surgical technique in both video and illustrative formats, with a step-by-step guide detailing the keys to a successful outcome.