Hemivertebrectomy in early onset scoliosis

Hemivertebra resection, first described by Royle in 1928, has become a routinely used technique in selected indication for congenital scoliosis. However controversies still exist between those who prefer convex epiphysiodesis rather than hemivertebrectomy and between the different techniques used to remove the hemivertebra. In this chapter emphasis will first be placed on the specific pathoanatomy of a hemivertebra, leading to a better understanding of the goals a surgeon must consider when performing a hemivertebrectomy. Attention must be paid not only to the frontal plane but also to the sagittal plane. Postoperative immediate and late stability must be obtained. There are different treatment options to remove a hemivertebra: anterior and posterior approach in a single operative session or through two separate sessions, posterior approach alone, eggshell procedure and the use of different implants such as hooks or pedicle screws.