A novel classification of subaxial cervical hemivertebrae and associated surgical management

Jinhui Wu; Miao Hu; Zhengbo Tao; Xin Zhou; Heng Jiang; Tao Lin; Jun Ma; Rui Gao; Ce Wang; Xuhui Zhou

doi:10.3389/fsurg.2023.1123397

A novel classification of subaxial cervical hemivertebrae and associated surgical management

Front Surg. 2023 Mar 17:10:1123397. doi: 10.3389/fsurg.2023.1123397. eCollection 2023.

Authors

Jinhui Wu¹, Miao Hu¹, Zhengbo Tao¹, Xin Zhou¹, Heng Jiang¹, Tao Lin¹, Jun Ma², Rui Gao¹, Ce Wang¹, Xuhui Zhou¹

Affiliations

¹ Department of Orthopedics, Changzheng Hospital, Shanghai, China.
² Department of Orthopedics, Shanghai General Hospital, Shanghai, China.

Abstract

Objective: To propose and validate a new classification of surgical methods for patients with subaxial cervical hemivertebrae.

Method: This article reviewed cases diagnosed with subaxial cervical hemivertebrae in our hospital from January 2008 to December 2019. The results of preoperative (initial visit), postoperative and/or final follow-up were assessed using the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, spinal balance parameters, and Scoliosis Research Society-22 Questionnaire (SRS-22). We also performed a reliability study to assess this classification.

Result: The classification includes three types. Each type can be divided into two subtypes, and a preliminary algorithm is proposed. Type I: There is an obvious appearance deformity in the neck, there are hemivertebrae in the cervical spine, and only a single hemivertebra of the subaxial cervical hemivertebra needs to be resected. Type II: There is an obvious appearance deformity in the neck, there are hemivertebrae in the cervical spine, and multiple subaxial cervical hemivertebrae need to be removed. Type III: No apparent deformity in the neck, at least one subaxial cervical hemivertebra existed or Klipper-Feil syndrome. Each type is divided into two subtypes, A and B, according to whether the upper and lower adjacent vertebral bodies of the rescected hemivertebra(e) are fused. We propose corresponding treatment methods for different types. We included a total of 121 patients and reviewed the prognosis for each type of patient. All patients achieved satisfactory results. The reliability study showed that the mean interobserver agreement was 91.8% (89.3%-93.4%), and the κ value was 0.845 (0.800-0.875). The intraobserver agreement ranged from 93.4% to 97.5%, with a mean κ value of 0.929 (0.881 to 0.954).

Conclusion: In our study, we proposed and validated a new classification of subaxial cervical hemivertebrae and proposed corresponding treatment plans for different classifications.

Keywords: cervical deformity; classification; hemivertebra; reliability study; surgical method.