• Jun Takahashi, Sohei Ebara, Hiroyuki Hashidate, Hiroki Hirabayashi, Nobuhide Ogihara, Keijiro Mukaiyama, and Hiroyuki Kato.
• Department of Orthopaedic Surgery, School of Medicine, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan. jtaka@shinshu-u.ac.jp
• J Orthop Sci. 2011 Sep 1;16(5):503-9.

BackgroundNo studies have reported on osteotomies utilizing a navigation system in congenital scoliosis surgery. This study aimed to evaluate the surgical outcomes of eight patients with congenital scoliosis or kyphoscoliosis due to hemivertebrae treated by computer-assisted hemivertebral resection using only a posterior approach.MethodsEight consecutive patients (two scoliotics and six kyphoscoliotics) managed by computer-assisted hemivertebral resection using only a posterior approach with transpedicular instrumentation were investigated retrospectively. A CT-based navigation system was used to confirm the positions of the vertebra, spinal cord and aorta in real-time when we inserted a pedicle screw and conducted the osteotomy. The mean patient age at surgery was 18 years (range 11-41 years). The mean follow-up was 46 months (range 18-84 months).ResultsBefore surgery, the mean kyphotic curve was 55.8° (range 26-83°), and the mean scoliotic curve was 50.0° (range 36-62°). At the final follow-up period, the curves averaged 23.2° (range 15-40°) and 31.6° (range 21-44°), respectively, yielding kyphotic angle corrections of 32.7° (range 11-58°) and Cobb angle correction rates of 36.8% (range 24.1-48.3%). A total of 72 pedicle screws were inserted with the navigation system, and two screws revealed a perforating pedicle. No neurovascular complications occurred. The perforation rate was 2.8%.ConclusionsHemivertebral resection via a single posterior approach is less invasive than combined anterior and posterior approaches; however, this procedure increases the risk of spinal cord and vascular injuries. Computer-assisted hemivertebral resection enables safe and accurate performance of a hemivertebral resection via a single posterior approach.

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