Congenital Scoliosis

Surgical Options

Hemi-Vertebra Resection

Some young children with scoliosis may have abnormally shaped vertebrae in their back that causes the curve. Normal vertebrae are shaped like rectangles. A hemi-vertebra (wedged vertebra) is shaped like a triangle or trapezoid. When a hemivertebra is located between two normal (rectangular) vertebra, a sudden, angular curve results (see Figure 1). If this hemi-vertebra is located at the bottom of the spine, it can tilt the base of the spine and cause the child lean to one side (see Figure 2). In other parts of the spine, depending on the number and location of the hemi-vertebrae, severe deformity can develop. At times, the hemi-vertebra may be removed from the front, back, or both parts of the spine. Once the hemi-vertebra is removed, the vertebrae above and below it are fused together - often with instrumentation. By removing the wedged vertebra, the adjacent normal vertebra will often correct the majority of the curve. Some children will wear a brace after the operation until the spine heals. This operation has inherent risks involved - including bleeding and neurologic injury - but good spinal correction is often achieved.

T12 hemi-vertebra

Figure 1: Front views (left pair) and side views (right pair) of an 8-year old child with a T12 hemi-vertebra (outlined in yellow). After the curve progressed to 40^o, the wedged vertebra was removed. The right image in each pair shows the postoperative X-rays with very little curve remaining.

hemi-vertebra between L5 and S1

Figure 2:
A) A hemi-vertebra between L5 and S1 (outlined in black). Note the anomalies in the sacrum below the wedge.
B) A front view of the spine before surgery.
C) A front view of the spine after surgery showing complete correction of the curve.
D&E) Beware of other anomalies! A CT scan (D) and MRI (E) showing a nerve root in the left L5 pedicle (where we place screws) forcing the surgeon to use a hook at this level.

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