AGE
8
CONDITION
Congenital scoliosis
CAUSE
L1 hemivertebra
Treatment
Resection and short fusion
Principle
Fuse minimal levels
Presentation
An eight-year-old had a congenital scoliosis with a truncal shift, a curve present from birth because a vertebra had not formed normally. For several years the spine stayed well balanced under close monitoring, exactly the conservative-first approach a growing spine calls for.
Investigation
Over time, a left L1 hemivertebra began driving the deformity and shifting the trunk to one side. Fortunately, a left T7 hemivertebra and a right T9 were balancing each other out, which meant the problem could be pinned to the single L1 level.
Shared decision
In a child this young, the guiding principle is to fuse as few levels as possible, preserving as much natural growth and movement as the correction allows. The plan was explained to the family in those terms: address the vertebra causing the problem, and leave the rest of the spine free.
Treatment
Using a 3D-printed model of the spine for planning and intraoperative 3D navigation for precision, the L1 hemivertebra was completely resected. A short fusion, two levels above and two below, was used mainly to restore the truncal shift, keeping the fusion as short as possible in a growing child.
Outcome
Removing the single driving vertebra realigned and rebalanced the rest of the spine, achieving the correction while fusing the fewest levels possible.
