What Is a Segmental Resection?

First approach the paravertebra by anterior approach, ligate the hemivertebrae and the segmental blood vessels next to the normal vertebrae 1 and 2 respectively, fully peel off the periosteum of the semivertebral body, and remove the upper and lower intervertebral disc fiber rings and adjacent normal vertebrae Cartilage plate. The posterior edge of the vertebral body is exposed, and then the pedicle of the vertebral body is removed. The posterior edge of the vertebral body was separated with a neurostripping device in an effort to preserve the posterior longitudinal ligament to reduce bleeding. First remove the anterior 4/5 of the hemivertebra with a rongeur or bone knife, then carefully remove the posterior wall.

Hemivertebral resection

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First approach the paravertebra by anterior approach, ligate the hemivertebrae and the segmental blood vessels next to the normal vertebrae 1 and 2 respectively, fully peel off the periosteum of the semivertebral body, and remove the upper and lower intervertebral disc fiber rings and adjacent normal vertebrae Cartilage plate. The posterior edge of the vertebral body is exposed, and then the pedicle of the vertebral body is removed. The posterior edge of the vertebral body was separated with a neurostripping device in an effort to preserve the posterior longitudinal ligament to reduce bleeding. First remove the anterior 4/5 of the hemivertebra with a rongeur or bone knife, then carefully remove the posterior wall.

Hemivertebral resection

Congenital scoliosis treatment for congenital scoliosis; Surgical correction of congenital scoliosis caused by hemivertebra in children

Pediatric Surgery / Spine Surgery

81.00

Hemivertebral resection is suitable for:

1. Hemivertebra of lumbosacral segment. Because it is usually accompanied by lateral incompensation, that is, the spinal line of gravity is significantly shifted to the convex side, other methods cannot correct this deformity.

2. The thoracolumbar hemivertebrae show short and sharp side curves, with obvious or decompensated curvature, and the hemivertebrae are indeed deformed apex.

The type of congenital hemivertebra is shown in Figure 12.29.4-1.

1. Systemic condition is bad, and there are important organ diseases.

2. Infective lesions on the skin near the surgical area.

1. Before the operation, explain the operation situation to the patient and make requirements to facilitate cooperation.

2. Train your bed to urinate.

3. Antibiotics were applied 1d before surgery.

4. Accurate measurement of malformation angle.

5. Prepare blood.

General anesthesia with endotracheal intubation was performed with the patient in a lateral position.

For local anatomy, see the schematic diagrams 12.29.4-2A and B.

Surgery is usually performed in two phases, anterior and posterior. It may also be completed in one phase.

Vertebral body resection

First approach the paravertebra by anterior approach, ligate the hemivertebrae and the segmental blood vessels next to the normal vertebrae 1 and 2 respectively, fully peel off the periosteum of the semivertebral body, and remove the upper and lower intervertebral disc fiber rings and adjacent normal vertebrae Cartilage plate. The posterior edge of the vertebral body is exposed, and then the pedicle of the vertebral body is removed. The posterior edge of the vertebral body was separated with a neurostripping device in an effort to preserve the posterior longitudinal ligament to reduce bleeding. First remove the anterior 4/5 of the hemivertebra with a rongeur or bone knife, then carefully remove the posterior wall.

2. Removal of hemi-spine attachment

The convex iliac spine muscle was detached from the lamina, and the lamina and upper and lower articular processes were detected, and then the lamina forceps were carefully removed. The pedicle of the same position must be removed, and the transverse process can be removed or left untreated.

3.Internal fixation

One of the following methods can be used: If the operation is divided into two phases, the internal fixation is not performed after the first phase of anterior surgery. In the second stage of posterior surgery, a Hastelloy pressure bar or other internal fixation system can be used on the convex side for orthosis. The concave side is strengthened and fixed with a spreading rod. For thoracolumbar or upper lumbar hemivertebrae over 8 years old, once the anterior and posterior hemivertebra resection is completed, it can be fixed with Zielke instruments. The vertebral body screws were inserted into the upper and lower vertebral bodies of the resection area, and then the threaded rod was turned and the nut was twisted to bring the upper and lower vertebral bodies closer to each other and the gap after osteotomy gradually disappeared. For young people, one can complete the anterior and posterior hemivertebral resection, and use lamina wire for internal fixation. During posterior surgery, a set of inferior laminar wires are placed on the convex side and in the upper and lower normal lamina, and the upper and lower laminar wires are tightened to each other, even if the deep laminar wire and the lower laminar shallow wire are paired, and the upper vertebra The shallow plate wire is intertwined with the deep plate wire.

4. Bone graft fusion

Regardless of whether the surgery is completed in stages or in one stage, cancellous bone should be packed in the intervertebral space of the osteotomy area, and conventional bone graft fusion should be performed at the rear.

1. When doing detachment of the lateral edge of the diseased vertebra, it should be peeled off along the periosteum, and the periosteum must not be penetrated, so as not to damage the large blood vessels and other organs.

2. The fixation of the lumbosacral segment is difficult. For juveniles, transpedicular screw fixators can be used with caution. For young children, it is not appropriate to use instruments for fixation. Orthopedic plaster can be used after surgery.

After hemivertebraectomy, do the following:

1. If the internal fixation has been done, plaster will be used for external fixation after the thread is removed.

2. If the internal fixation is not done, the orthopedic plaster will be bandaged immediately after the operation, as described in posterior fusion.

Spinal cord injury

The spinal cord may be injured when the hemivertebrae are exposed and the hemivertebrae are removed. Once this happens, drugs such as hormones and dehydration should be given in time.

Spondylolisthesis

After the diseased vertebra is completely removed, if the internal fixation is not reliable, it can cause spinal detachment. The preventive measure is that the internal fixation should be firm and reliable, and the external fixation of the gypsum vest should be long enough.