Hemivertebra Excision-Posterior-Only Approach With 3-Rod Technique

Posterior-only hemivertebra (HV) excision (PHVE) is an effective treatment for isolated hemivertebrae that cause significant local deformity. Multiple balanced hemivertebrae or global structural deformity is probably not appropriate for PHVE. PHVE works well in cervicothoracic, thoracolumbar, lumbar, and lumbosacral locations, with varying degrees of technical difficulty, while midthoracic PHVE seems less effective. Associated segmental kyphotic deformity is most easily treated, whereas segmental lordosis can be problematic with a posterior-only approach. Careful preoperative anatomical assessment and attention to operative detail can accomplish complete segmental correction without injuring or involving adjacent motion segments. Surgeon skillset for this procedure should include pedicle screw placement in small children and manipulation of the dura dural and control of epidural bleeding.