Dorsal hemivertebrae in children's lumbar spines

STUDY DESIGN: Only small numbers patients with dorsal hemivertebrae have been reported. The natural course of this disease remains unpredictable, especially regarding the development of neurologic impairment. Two children with congenital dorsal hemivertebra with progressive kyphosis of the lumbar spine are presented. Onset and method of treatment are discussed. OBJECTIVES: Two boys with kyphosis due to dorsal hemivertebrae of the lumbar spine were followed with clinical examination, anteroposterior roentgenograms, and magnetic resonance imaging. One patient was in follow-up for more than 4 years postoperatively. The other patient, who has not undergone surgery, has been in follow-up for more than 2 years, undergoing reassessment every 4 to 6 months. SUMMARY OF BACKGROUND DATA: Spastic paralysis developed in one patient with dorsal hemivertebra and spina bifida. The other patient with dorsal hemivertebra and sacral agenesis had no neurologic deficit. METHODS: A dorsal approach with resection of the dorsal hemivertebra and short dorsal fusion with internal fixation was done in one patient. The other patient underwent clinical and radiologic follow-up. Method and onset of surgical treatment were compared with other studies. RESULTS: Progressive spasticity was seen in our first patient. This could be reversed by resection of the hemivertebra and monosegmental fusion. Alignment of the spine and normalization of the width of spinal canal were achieved. The second patient has not had a neurologic problem. Surgical treatment will be performed when indicated. CONCLUSIONS: A posterior approach is recommended for a dorsal hemivertebra. Decompression of the spinal canal can be achieved by resection of the dorsal hemivertebra and short dorsal fusion with internal fixation. Surgery should be done early to avoid late neurologic impairment.