Sagittal Spinal Profile in Patients with Lumbosacral Hemivertebra: Preoperative Status and Postoperative Evolution at a Mean Follow-up of 7.5 Years.

Abstract

Background: A lumbosacral hemivertebra (LSHV) presents a complex challenge in treating congenital scoliosis. Previous studies have proven the effectiveness of posterior LSHV resection. However, they have primarily focused on coronal balance, neglecting the sagittal alignment, which is crucial for spinal function. The aim of this retrospective study was to assess preoperative sagittal imbalance in patients with an LSHV and to evaluate the evolution of sagittal alignment following posterior hemivertebra resection and short-segment fusion.

Methods: A retrospective analysis was performed that included 58 patients with LSHV who underwent posterior LSHV resection between 2010 and 2020 and had a mean follow-up duration of 7.5 years. All patients were Han Chinese, and 30 of the 58 patients were female. The mean age was 7.3 years. Sagittal balance parameters were measured preoperatively and at multiple postoperative time points. Clinical outcomes were assessed with use of the Scoliosis Research Society (SRS)-22 questionnaire.

Results: Preoperatively, 60.3% of patients presented with sagittal imbalance (defined as a sagittal vertical axis [SVA] of >20 mm). Postoperatively, the mean SVA significantly improved, decreasing to <20 mm at the 1-year follow-up (p = 0.016). The pelvic incidence-lumbar lordosis mismatch (PI-LL) also showed significant improvement at the immediate postoperative time point (p = 0.012) and at the last follow-up (p = 0.013). Patients who underwent anterior column reconstruction demonstrated better postoperative global sagittal balance than those who did not (SVA, p = 0.015; PI-LL, p < 0.001). SRS-22 total, self-image, and satisfaction scores significantly (p < 0.001) improved postoperatively.

Conclusions: This study highlighted the prevalence of preoperative sagittal imbalance in patients with an LSHV and emphasized the impact of LSHV resection (particularly when accompanied by anterior column reconstruction) in achieving postoperative sagittal balance and in enhancing patient quality of life during the long-term follow-up period.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.