Surgical Results in Hemivertebrae-induced Congenital Scoliosis: A Mean 10-year Follow-up Study

Purpose Congenital scoliosis caused by hemivertebrae is one of the most challenging deformities in pediatric spinal surgery. This study aims to evaluate the long-term surgical outcomes in patients with hemivertebrae-induced congenital scoliosis, compare the effects of different deformity types and surgical techniques on radiological and clinical results, and determine the sustainability of the achieved correction. Methods Between 2009 and 2019, 38 patients operated on by a single surgeon were retrospectively reviewed. The patients were classified according to deformity type — isolated hemivertebrae (H1) and complex deformities (H2) — and according to surgical technique — instrumentation and fusion alone (Group C) versus hemivertebrae resection with short-segment fusion (Group R). Segmental coronal Cobb angle, compensatory curves, kyphotic angle, and coronal balance parameters were measured preoperatively, early postoperatively, and at final follow-up. Intra-group and inter-group comparisons were performed, and a p-value of < 0.05 was considered statistically significant. Results The mean preoperative segmental Cobb angle was 44°, which improved to 17° postoperatively, corresponding to a 64% correction maintained at long-term follow-up (p < 0.001). The correction rate was 66% in the resection group (Group R) and 59% in the correction-only group (Group C), with a statistically significant difference favouring Group R (p < 0.05). No significant loss of correction was observed between early postoperative and final follow-up measurements in either group. However, at the last follow-up, the segmental coronal angle was significantly lower in Group R (p = 0.018). The complication rates were comparable between the two groups. Conclusion Long-term outcomes indicate that posterior-based treatments achieve stable radiological correction in hemivertebrae-induced congenital scoliosis. Resection with short-segment fusion offers better alignment and less extensive fusion than instrumentation alone but may slightly increase the risk of complications. Individualised management remains essential to prevent secondary structural deformities and ensure lasting correction. Further studies with larger series are needed to better characterise the spectrum of complications and to explore evolving surgical strategies for addressing the technical challenges of this demanding procedure.