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Twenty-four cases of lumbosacral hemivertebrae are reviewed. The treatment groups consisted of observation, bracing, posterior spinal fusion with and without Harrington instrumentation, and two-stage hemivertebral excision. Clinical and radiographic spine decompensation was found to be an important parameter in following these patients. Results with observation and bracing were variable and unpredictable. The best surgical correction was obtained with lumbosacral hemivertebral excision.