Hemi-vertebra Excision and Fusion for Congenital Scoliosis and Kyphosis

Benefits of the Procedure:

• Correction of Spinal Alignment: Surgery can effectively straighten the spine, improving posture and overall spinal alignment.

• Prevention of Curve Progression: Early surgical intervention can halt the worsening of spinal curvature, maintaining a more natural spinal shape.

• Pain Reduction: By addressing the structural issues of the spine, surgery can alleviate associated discomfort and pain.

• Enhanced Mobility: Correcting spinal deformities can lead to improved movement and flexibility, facilitating better daily functioning.

• Improved Aesthetic Appearance: Surgical correction can enhance the physical appearance of the back, which may boost self-esteem and body image.

What Health Conditions Require Hemi-vertebra Excision and Fusion?

Hemi-vertebra excision and fusion are primarily performed for congenital spinal deformities that result from an abnormal vertebra disrupting spinal alignment. The presence of a hemi-vertebra can lead to varying degrees of curvature, affecting different sections of the spine. The procedure is specifically indicated for:

Congenital Scoliosis: Congenital scoliosis is a spinal deformity from birth caused by improper vertebral development. A hemi-vertebra can create a sharp angulation in the spine, leading to a sideways curvature. Unlike idiopathic scoliosis, which develops gradually, congenital scoliosis often progresses rapidly, especially during growth spurts. If left untreated, the curvature may worsen, leading to postural imbalance, difficulty in walking, and, in severe cases, lung or heart compression. Hemi-vertebra excision corrects the structural defect, allowing the spine to grow in a more natural alignment.

Congenital Kyphosis: Congenital kyphosis occurs when a hemi-vertebra leads to an excessive forward bend in the spine, resulting in an abnormally rounded back. This condition can cause postural instability, chronic back pain, and, in severe cases, neurological symptoms due to spinal cord compression. Unlike postural kyphosis, which can be managed with therapy, congenital kyphosis often requires surgical correction due to its rigid nature. Excision of the hemi-vertebra helps restore spinal balance and prevents worsening deformity over time.

Mixed Spinal Deformities Due to Hemi-vertebrae: In some cases, a hemi-vertebra may contribute to both scoliosis and kyphosis, leading to a complex spinal deformity affecting multiple alignment planes. This can result in severe spinal imbalance, making it difficult to maintain an upright posture or move comfortably. Mixed spinal deformities require precise surgical planning to remove the abnormal vertebra while ensuring adequate spinal support. Hemi-vertebra excision combined with fusion helps stabilise the spine, allowing for a more natural posture and improved mobility.

Indications for Hemi-vertebra Excision and Fusion:

Hemi-vertebra excision and fusion are surgical procedures aimed at correcting congenital spinal deformities. The primary indications for these procedures include:

• Progressive Spinal Curvature: Worsening scoliosis or kyphosis resulting from a hemi-vertebra that continues to progress despite conservative management.

• Severe Spinal Deformity: Significant spinal curvature present at an early age, particularly when the deformity is likely to lead to further complications if left untreated.

• Anticipated Curve Progression: Congenital scoliosis cases where the hemi-vertebra is expected to cause substantial spinal curvature as the child grows, warranting proactive surgical intervention.

• Associated Neurological Symptoms: Presence of neurological deficits or symptoms attributable to spinal cord compression or deformity caused by the hemi-vertebra.

• Failure of Conservative Treatments: Ineffectiveness of non-surgical approaches, such as bracing, in halting the progression of the spinal deformity.

Key Aspects of the Surgical Procedure:

Hemi-vertebra excision and fusion is a surgical procedure aimed at correcting congenital spinal deformities by removing anomalous vertebral segments and stabilising the spine. The key aspects of this procedure include:

• Surgical Approach: Typically performed through a posterior-only approach, allowing for direct access to the hemi-vertebra and facilitating simultaneous correction of spinal alignment.

• Hemi-vertebra Resection: Complete removal of the hemi-vertebra, including its posterior elements, vertebral body, and adjacent intervertebral discs, to eliminate the source of the deformity.

• Spinal Fusion: Following resection, a spinal fusion of the adjacent vertebrae is performed using bone grafts and instrumentation, such as pedicle screws and rods, to stabilize the spine and promote bone healing.

• Correction of Spinal Alignment: The procedure aims to correct abnormal spinal curvature, such as scoliosis or kyphosis, by realigning the spine during surgery.

• Postoperative Care: Patients typically undergo a period of immobilisation and are monitored for potential complications, with follow-up imaging to assess spinal alignment and fusion status.

Will I Need Any Pre-Procedure Investigations?

Step-by-Step Breakdown

Medical Evaluation: A comprehensive medical assessment evaluates overall health, pre-existing conditions, and potential surgical risks. This includes a detailed review of your medical history, current medications, and previous surgeries. If you have underlying conditions such as heart disease, respiratory issues, or clotting disorders, additional precautions may be taken to ensure a safe procedure.

Imaging and Diagnostic Assessments: Detailed imaging is crucial for surgical planning. X-rays, CT scans, and MRI scans are used to assess the exact location and severity of the spinal deformity. These images help surgeons determine the safest and most effective approach for hemi-vertebra excision while avoiding damage to surrounding nerves and tissues. In some cases, 3D imaging may be used for enhanced surgical precision.

Adjusting Medications: Certain medications may need to be adjusted before surgery to minimise complications. For example, if you take blood thinners or anticoagulants, your doctor may advise temporarily discontinuing them to reduce the risk of excessive bleeding. Medications for chronic conditions, such as diabetes or hypertension, will be carefully managed to ensure stability before and after the procedure.

Preoperative Physical Preparation: Strengthening your body before surgery can aid in recovery. Your doctor may recommend light exercises or physical therapy to improve overall conditioning. A balanced diet rich in protein, vitamins, and minerals supports tissue healing. In some cases, nutritional supplements may be prescribed to optimise bone health before the fusion procedure.

Informed Consent and Patient Counselling: Before surgery, your doctor will explain the procedure, including potential benefits, risks, and expected recovery. This is an opportunity to address any concerns and clarify post-surgical expectations. Informed consent ensures that you fully understand the procedure and agree with confidence.

What Happens During the Procedure?

Hemi-vertebra excision and fusion are highly specialised procedures that require meticulous planning and precision. The goal is to remove the abnormal vertebra while maintaining spinal stability and preventing further curvature. Advanced imaging and surgical techniques ensure safety and effectiveness throughout the process.

Anaesthesia and Positioning: The procedure begins with general anaesthesia to ensure complete comfort and immobility. You are positioned carefully on the operating table, typically prone (face-down), to allow optimal access to the affected spinal area. Proper padding and support prevent pressure-related complications and maintain alignment during surgery.

Identifying the Hemi-vertebra: The surgical team precisely identifies the location of the hemi-vertebra using real-time fluoroscopic imaging. A midline or slightly lateral incision is made over the spine, and the underlying muscles are gently retracted to expose the affected vertebra while preserving surrounding nerves and tissues.

Surgical Excision of the Hemi-vertebra: Once exposed, the hemi-vertebra is carefully removed in a controlled manner. Depending on the severity, partial or complete removal may be necessary. The surgeon ensures that nearby spinal structures remain intact while eliminating the primary cause of the deformity. Affected intervertebral discs are also removed to facilitate proper spinal alignment.

Spinal Fusion and Stabilisation: To restore stability, spinal fusion is performed. Bone grafts, often taken from the patient's iliac crest (hip bone) or from allograft sources, are placed between the adjacent vertebrae to encourage new bone formation. Titanium rods, screws, or plates hold the spine in the correct position while fusion occurs. This step prevents the recurrence of spinal curvature and promotes long-term structural integrity.

Closure and Postoperative Assessment: Once the fusion components are secured, the surgical site is meticulously closed layer by layer to minimise tissue trauma. A postoperative assessment ensures that spinal alignment, nerve function, and blood circulation remain intact. You are then transferred to the recovery unit for close monitoring as the anaesthesia wears off.

How long does it take to recover from a Hemi-vertebra Excision and Fusion?

A structured recovery plan is vital for achieving the best long-term results after surgery. Your rehabilitation will focus on healing, strengthening, and adapting to the corrected spinal alignment.

• Immediate Postoperative Recovery: You will be closely monitored in the recovery unit to ensure stable vital signs, pain control, and neurological function. Although initial mobility may be restricted, your medical team will assist with gradual movement as healing progresses.

• Physical Therapy and Rehabilitation: Physical therapy begins within the first few weeks after surgery to restore mobility and muscle strength. Gentle exercises help improve posture, enhance flexibility, and prevent stiffness. Your therapist will provide personalised guidance on safe movements and activities.

• Long-Term Recovery and Follow-Up Care: Spinal fusion takes several months to stabilise fully. Regular follow-up appointments allow your doctor to monitor bone healing and spinal alignment. Imaging tests, such as X-rays or CT scans, may be performed to assess fusion progress. Restrictions on high-impact activities will be gradually lifted as your spine gains strength.

• Adjusting to Spinal Correction and Mobility: Your body will adapt to the corrected spinal alignment over time. As healing continues, you may notice an improvement in posture, balance, and comfort. While minor adjustments in movement patterns may be necessary, most individuals resume normal daily activities with improved spinal stability.

How to Know if I Am Eligible for Hemi-vertebra Excision and Fusion?

Hemi-vertebra excision and fusion are recommended when congenital spinal deformities cause progressive curvature, postural instability, or potential neurological complications. Early intervention is crucial to prevent worsening deformity and associated health risks. Your doctor may recommend this procedure if:

Your spinal curvature is worsening over time. Untreated congenital spinal misalignment increases with growth and can lead to severe deformity, making correction more complex if delayed.

You experience postural imbalance or mobility issues. Severe spinal curvature can affect your ability to stand upright, walk comfortably, or maintain normal posture.

There is a risk of spinal cord compression. In some cases, a malformed vertebra may press against the spinal cord, leading to pain, numbness, or limb weakness.

Conservative treatments have not been effective. If bracing or physical therapy cannot control the progression of scoliosis or kyphosis, surgical correction may be necessary.

Your spine is still growing. Performing the procedure early in life allows for better long-term spinal alignment and reduces future complications.

Risks or Side Effects of Hemi-vertebra Excision and Fusion:

As with any surgical procedure, hemi-vertebra excision and fusion carry certain risks. However, complications can be minimised with skilled surgical techniques and proper post-operative care.

• Infection: Strict sterile protocols and post-surgical antibiotics reduce the risk of infection at the surgical site.

• Bleeding or Blood Clot Formation: Preoperative assessments help identify and manage bleeding risks to ensure a safe procedure.

• Nerve Damage: Although rare, spinal surgery carries a small risk of nerve injury, which may lead to weakness or sensory changes.

• Fusion Failure: In some cases, the bone graft may not fully integrate, requiring additional intervention.

• Postoperative Stiffness: While spinal fusion stabilises the spine, it may slightly reduce flexibility in the fused area.

Your doctor will discuss these risks in detail and take all necessary precautions to ensure a successful and safe outcome.

Why Choose MIRSS for Hemi-vertebra Excision and Fusion?

Choosing the right medical centre for spinal surgery is crucial for achieving the best outcome. MIRSS offers world-class expertise, cutting-edge technology, and comprehensive post-surgical care to ensure a safe and successful recovery. If you are in search of the best spine surgery hospital in Bangalore, choose MIRSS for these reasons:

• Expert Spine Surgeons: Our team includes leading specialists in pediatric and adult spinal surgery, ensuring precise correction of congenital spinal deformities.

• Advanced Imaging and Navigation Systems: State-of-the-art imaging techniques, such as 3D fluoroscopy and intraoperative CT scans, enhance surgical precision and safety.

• Minimally Invasive Techniques When Applicable: Our surgeons employ the latest techniques to minimise tissue trauma, reduce postoperative pain, and accelerate recovery.

• Comprehensive Preoperative and Postoperative Care: From detailed surgical planning to personalized rehabilitation programs, our multidisciplinary team supports you at every stage.

• High Success Rates in Spinal Deformity Correction: Our hospital is known for its excellent outcomes in treating complex spinal conditions and ensuring long-term health.