POSTERIOR-ONLY HEMIVERTEBRA RESECTION IN CONGENITAL SCOLIOSIS: EGGSHELL TECHNIQUE VERSUS RADICAL EXCISION

Congenital scoliosis results from vertebral malformations present at birth and may progress substantially during growth, frequently requiring surgical treatment. Hemivertebra resection can be performed using a less radical eggshell technique or by complete radical excision. We compared radiographic outcomes, perioperative parameters and complications between these two posterior-only techniques. Between 2018 and 2023, 32 pediatric patients (10 boys and 22 girls) underwent posterior-only hemivertebra resection for congenital scoliosis. Eggshell osteotomy was performed in 20 patients and radical hemivertebra resection in 12. Mean age at surgery was 5.5 years (range 3 to 16), with a minimum follow-up of two years. In the eggshell group, the mean main curve measured 67 degrees preoperatively, 16 degrees postoperatively and 20 degrees at final follow-up. In the radical resection group, corresponding values were 85 degrees, 17 degrees and 21 degrees. Mean correction was 63% and 59%, respectively, with loss of correction of 6% and 7% at final follow-up. No neurological complications occurred in either group. Mean operative time was 3.5 hours for eggshell osteotomy and 4.5 hours for radical resection, while mean estimated blood loss was 320 mL and 530 mL, respectively. Both techniques provided effective deformity correction. Eggshell osteotomy achieved comparable radiographic correction with shorter operative time and lower blood loss and may be a less aggressive option, particularly in younger children. Radical resection may be more demanding and may require anterior column reconstruction, although bone-on-bone closure may support fusion and reduce the risk of pseudarthrosis.