Vice Chairman & Head - Ortho Spine, MIS & Robotic Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi
Part 5 of 18 in Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
August 5, 2026
A hemivertebra, a half-formed vertebra present from birth, should be surgically corrected as soon as a child turns four or five years old, when the procedure takes only two to three hours, rather than left untreated, when it can progress into a severe deformity requiring 16 hours of surgery in the teenage years. This single decision point is one of the clearest lessons in paediatric spine surgery.
What a hemivertebra is and why early treatment matters
A hemivertebra is a half-formed vertebra that causes the spine to tilt progressively to one side as the child grows. As soon as a hemivertebra is detected on an X-ray, once the child reaches four or five years of age, they should be referred immediately for correction. At this age, removing the small hemivertebra and performing a limited correction and fusion takes only two to three hours, and normal growth resumes from the very next day.
Why hemivertebra cases are often neglected
Many hemivertebra cases are neglected, either because families do not know where to seek treatment, or because of a general lack of awareness among the public and doctors, and persistent but scientifically unfounded beliefs that the deformity will correct itself as the child grows.
What happens when treatment is delayed
One girl with a neglected hemivertebra was not treated until she was 16 years old, by which point she had a severe hump, kyphotic deformity, shoulder imbalance and malalignment affecting the vertebrae above and below the original defect. Correcting this required an extended vertebral column resection, removing the entire affected vertebra plus half of another, together with long-segment fixation and a three-level decompression, a 16-hour operation involving more than two litres of blood loss, compared with the two to three hour procedure that early treatment would have required.
How modern technology supports these complex corrections
Ultrasonic bone-cutting instruments, which cut precisely like a pen without generating the heat of a standard drill, were used in this case. Because they work through ultrasonic vibration rather than electrical or thermal energy, they automatically stop on contact with nerve tissue, and the bone removed can be reused as a bone graft. Despite the complexity of this delayed case, the patient stood up in the intensive care unit the day after surgery with good shoulder balance, no neurological deficit, no leg weakness and no numbness, showing what is possible even in advanced, neglected spinal deformity.
← Growth Rods for Early-Onset Scoliosis in Young Children | Series index | Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect →
This article is based on a Jivo Masterclass session conducted by Dr. Puneet Girdhar, Chairman, Max Institute of Robotics and Minimal Invasive Spine Surgery, BLK-Max Super Speciality Hospital, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass — Dr. Puneet Girdhar taught doctors across Africa on August 10, 2025.
FROM THE LIVE Q&A
Dr. Frank, referring physician, Ghana
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.
Dr. Puneet Girdhar
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
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Frequently Asked Questions
I'm also trying to go into orthopedic surgery myself, and I'm really happy learning more about it and seeing the advances in the surgery you're doing. Out of curiosity — how many of your own fellows go on to specialize in spine surgery after training under you?▼
I always joke about this with my orthopedic fellows. I've had an orthopedic training program for the last 13 or 14 years, and not even one of them has opted for spine surgery as a career — they're very happy doing a knee replacement, arthroscopy, or a fracture nail instead. Spine surgery has evolved so much that the moment they look into the scope, everything is very tiny, and that can be discouraging — it looks very uphill. It takes a little while to enter the system and understand what's going on through keyholes; one has to be patient, because it has a steep learning curve and the margin of error is not there. So for the last four years I've run a dedicated fellowship national training program for spine fellows — once they're selected and come to me, they don't have the option to go to any other theatre, because they're now committed to spine surgery for the rest of their life.
I wanted to share how Paulina has been doing since her surgery with you — honestly speaking, I was really impressed by her recovery time. She's come back to Ghana and she's always praising your team, and now I have even more patients lining up who also want to come and have a consultation, and possibly the surgery, after hearing about her experience.▼
We feel privileged to be treating your patient, and I hope we have done justice to you, your practice and of course the patient. I think at the end of the day we all have one common goal — we want to see our patients happy. Otherwise you, me and Jivo would not be here on a Sunday evening, leaving our families aside, if we did not have this goal.
What is a hemivertebra?▼
It is a half-formed vertebra present from birth that causes the spine to tilt progressively to one side as the child grows.
When should a hemivertebra be treated?▼
As soon as it is detected on an X-ray and the child reaches four or five years of age, when correction takes only two to three hours and normal growth resumes from the next day.
Why do hemivertebra cases often go untreated for years?▼
Neglect usually stems from families not knowing where to seek treatment, general lack of awareness among the public and doctors, and a persistent but scientifically unfounded belief that the deformity will correct itself as the child grows.
What does surgery involve if a hemivertebra is left untreated into the teenage years?▼
A case treated at 16 years required an extended vertebral column resection, removing the entire affected vertebra plus half of another, together with long-segment fixation and a three-level decompression, a 16-hour operation involving more than two litres of blood loss, compared with the two to three hour procedure early treatment would have required.
What role do ultrasonic bone-cutting instruments play in complex spinal deformity surgery?▼
These instruments cut precisely through bone without generating the heat of a standard drill, and because they work through ultrasonic vibration rather than electrical or thermal energy, they automatically stop on contact with nerve tissue, while the bone removed can be reused as a graft.
In This Series: Spinal Surgery: Advances in Techniques & Technology for Excellent Patient Outcomes
- 1.Advances in Spinal Surgery
- 2.Biportal Endoscopic Spine Surgery: What It Is and How It Works
- 3.Cervical Disc Replacement: Treating Neck Disc Herniation While Preserving Motion
- 4.Growth Rods for Early-Onset Scoliosis in Young Children
- 5.Hemivertebra: Why Early Surgery Prevents Severe Spinal Deformity
- 6.Herniated Disc Surgery: Biportal Endoscopic Discectomy Explained
- 7.Kyphoplasty for Osteoporotic Spinal Fractures: A Same-Day Procedure
- 8.Lumbar Canal Stenosis: Symptoms and Modern Minimally Invasive Treatment
- 9.Minimally Invasive Spinal Fusion: Treating Spinal Instability Without Open Surgery
- 10.Minimally Invasive vs Open Spine Surgery: How Techniques Have Evolved
- 11.Navigation and Robotics in Spine Surgery: Why They Improve Accuracy and Safety
- 12.Prolonged Sitting and Disc Degeneration: Why Desk Jobs Are a Spine Risk
- 13.Recovery After Minimally Invasive Spine Surgery: What Patients Can Expect
- 14.Robotic Spine Surgery for Complex and Revision Cases
- 15.Scoliosis and Kyphosis in Children: Types and Warning Signs
- 16.Scoliosis Treatment: When Observation, Bracing or Surgery Is Needed
- 17.Vertebral Column Resection: Correcting Severe Spinal Deformity From Neglected Tuberculosis
- 18.When to See a Spine Specialist: Warning Signs You Shouldn't Ignore