# Unilateral biportal endoscopic lumbar hemivertebra resection with bilateral percutaneous fixation in a pediatric patient: a case report

## TL;DR

A new minimally invasive surgical technique successfully corrected spinal deformity in a child by removing a hemivertebra and using percutaneous fixation.

## Contribution

This case report introduces a combined UBE and percutaneous fixation protocol for pediatric spinal deformity correction.

## Key findings

- The procedure achieved a 56% segmental correction of spinal deformity with minimal blood loss.
- Radiographic fusion was observed at 6-month follow-up with no complications.
- The surgery used only four small incisions, demonstrating minimal tissue disruption.

## Abstract

Minimally invasive techniques are gaining interest in pediatric spinal deformity surgery. Unilateral biportal endoscopy (UBE) offers precise visualization with minimal tissue disruption. However, achieving sufficient biomechanical stability after a major osteotomy, such as hemivertebra (HV) resection, remains critical.

A 7-year-old girl with progressive congenital scoliosis (CS) (segmental Cobb angle 32°) due to a left L4/L5 semi-segmented HV underwent complete HV resection via UBE. Using a fully percutaneous technique, the UBE portals were reused for ipsilateral pedicle screw insertion at L4 and L5. Two additional contralateral stab incisions enabled bilateral percutaneous screw placement, followed by rod insertion and compression.

The 210-minute procedure achieved a 56% segmental correction (32° to 14°), with estimated blood loss of 100 mL. At 6-month follow-up, correction was maintained (Cobb 14°) with evidence of radiographic fusion and no complications. The entire procedure required only four stab incisions (each 1–1.5 cm).

UBE enables precise lumbar HV resection under direct visualization. When synergized with bilateral percutaneous short-segment fixation, it provides the mechanical integrity essential for maintaining correction. This combined protocol successfully marries minimal tissue disruption with surgical efficacy, offering a promising alternative within the minimally invasive armamentarium for pediatric spinal deformity.