Posterior hemivertebra resection in children younger than three years: a single-center retrospective case series of medium-term outcomes, complications, and technical considerations

Abstract

The surgical management of hemivertebra in children younger than three years remains controversial because of technical complexity, growth-related uncertainty, and the potential for clinically relevant complications. This study aimed to evaluate the clinical and radiological outcomes, complication profile, and technical considerations of posterior hemivertebra resection in carefully selected children younger than three years. Methods A retrospective consecutive case series was conducted on patients who underwent posterior hemivertebra resection before the age of three years between 2013 and 2023. Patient-level variables included demographics, follow-up, and complications, whereas hemivertebra-specific radiographic and construct variables were reported descriptively. Patients with single or multiple hemivertebrae were included if adequate clinical and radiological follow-up data were available; patients with prior spinal surgery or additional segmentation failure were excluded. Results Nineteen patients (23 hemivertebrae) met the inclusion criteria. The mean surgical age was 23.5 ± 7.5 months, and the median follow-up was 61 months (range, 24–121 months). The mean coronal segmental Cobb angle improved from 33.0° ± 9.3° preoperatively to 5.2° ± 4.7° postoperatively and measured 6.0° ± 6.8° at final follow-up, corresponding to an initial correction of 85.4% ± 11.0% and 82.8% ± 18.4% at final follow-up. Cranial compensatory curves showed a correction of 64.4% ± 31.0% postoperatively and 80.0% ± 26.5% at final follow-up, while caudal curves achieved 61.1% ± 19.3% and 63.7% ± 33.2%, respectively. The mean operative time was 359.6 ± 93.5 min, with a mean blood loss of 183.3 ± 124.5 mL and a hospital stay of 5 ± 2 days. Six complications occurred in five patients, including one early implant failure, two cases of progressive new curve formation requiring growing-rod surgery, one case of hemivertebra regrowth/recurrence, and two superficial wound complications. No neurological deficits were observed. Conclusion Posterior hemivertebra resection before the age of three can provide substantial correction of congenital spinal deformity in selected patients when performed in specialized centers using modern navigation, neuromonitoring, and stable fixation strategies. However, the procedure is technically demanding and is associated with a clinically relevant complication profile. These findings should therefore be interpreted as medium-term outcomes from a small retrospective single-center series, and longer follow-up through skeletal maturity is required before definitive conclusions can be drawn regarding long-term durability and overall safety.