Fractional curve progression with maintenance of fusion mass in congenital scoliosis

Dong Gune Chang, Jae Hyuk Yang, Se Il Suk, Seung-Woo Suh, Jin Hyok Kim, Seung Joo Lee, Ki Ho Na, Jung Hee Lee

Research output: Contribution to journalArticle

Abstract

Rationale: The management of congenital scoliosis concentrates on early diagnosis and proper surgical treatment before the development of severe deformities. Decision making regarding the appropriate fusion levels, proper surgical treatment, and reduction amount of kyphoscoliosis is very important but difficult in the treatment of congenital scoliosis, especially in young children. Patient concerns: We report an 11-year follow-up of revision surgery for fractional curve progression after combined anterior and posterior fusion without hemivertebra resection using pedicle screw fixation (PSF) in congenital kyphoscoliosis at age 4 years (a total 18-year follow-up). A T12 hemivertebra was documented in a 4-year-old girl and was treated by combined anterior and posterior fusion in two stages with PSF. The fusion mass was maintained but the distal compensatory curve progressed during the follow-up period. The patient underwent a posterior vertebral column resection (PVCR) with extended posterior fusion at the age of 11, 7 years after initial surgery. Outcomes: Eleven years after the revision surgery with PVCR, the patient showed satisfactory results and her spine was well balanced. Lessons: The cause of revision surgery for the curve progression may include inappropriate fusion level, incomplete hemivertebra resection, or failure of anterior and posterior fusion. Especially, inappropriate fusion level may result in deterioration of the compensatory curve even without progression of the fusion mass. Conclusion: Appropriate selection of fusion levels, complete resection of hemivertebra, and satisfactory reduction of scoliosis and kyphosis are important factors for deformity correction and prevention of progression of both main and compensatory curves (adding-on of structural curve or progression of compensatory curve) as well as reducing the influence of adjacent vertebral growth using as short a fusion as possible.

Original languageEnglish
Article numbere7746
JournalMedicine (United States)
Volume96
Issue number36
DOIs
Publication statusPublished - 2017 Sep 1

Fingerprint

Scoliosis
Reoperation
Spine
Maintenance
Kyphosis
Early Diagnosis
Decision Making
Therapeutics
Growth
Pedicle Screws

Keywords

  • congenital scoliosis
  • curve progression
  • fusion level
  • hemivertebra
  • posterior vertebral column resection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Fractional curve progression with maintenance of fusion mass in congenital scoliosis. / Chang, Dong Gune; Yang, Jae Hyuk; Suk, Se Il; Suh, Seung-Woo; Kim, Jin Hyok; Lee, Seung Joo; Na, Ki Ho; Lee, Jung Hee.

In: Medicine (United States), Vol. 96, No. 36, e7746, 01.09.2017.

Research output: Contribution to journalArticle

Chang, Dong Gune ; Yang, Jae Hyuk ; Suk, Se Il ; Suh, Seung-Woo ; Kim, Jin Hyok ; Lee, Seung Joo ; Na, Ki Ho ; Lee, Jung Hee. / Fractional curve progression with maintenance of fusion mass in congenital scoliosis. In: Medicine (United States). 2017 ; Vol. 96, No. 36.
@article{ecbd2f13342045969bfbf9ebe28464c3,
title = "Fractional curve progression with maintenance of fusion mass in congenital scoliosis",
abstract = "Rationale: The management of congenital scoliosis concentrates on early diagnosis and proper surgical treatment before the development of severe deformities. Decision making regarding the appropriate fusion levels, proper surgical treatment, and reduction amount of kyphoscoliosis is very important but difficult in the treatment of congenital scoliosis, especially in young children. Patient concerns: We report an 11-year follow-up of revision surgery for fractional curve progression after combined anterior and posterior fusion without hemivertebra resection using pedicle screw fixation (PSF) in congenital kyphoscoliosis at age 4 years (a total 18-year follow-up). A T12 hemivertebra was documented in a 4-year-old girl and was treated by combined anterior and posterior fusion in two stages with PSF. The fusion mass was maintained but the distal compensatory curve progressed during the follow-up period. The patient underwent a posterior vertebral column resection (PVCR) with extended posterior fusion at the age of 11, 7 years after initial surgery. Outcomes: Eleven years after the revision surgery with PVCR, the patient showed satisfactory results and her spine was well balanced. Lessons: The cause of revision surgery for the curve progression may include inappropriate fusion level, incomplete hemivertebra resection, or failure of anterior and posterior fusion. Especially, inappropriate fusion level may result in deterioration of the compensatory curve even without progression of the fusion mass. Conclusion: Appropriate selection of fusion levels, complete resection of hemivertebra, and satisfactory reduction of scoliosis and kyphosis are important factors for deformity correction and prevention of progression of both main and compensatory curves (adding-on of structural curve or progression of compensatory curve) as well as reducing the influence of adjacent vertebral growth using as short a fusion as possible.",
keywords = "congenital scoliosis, curve progression, fusion level, hemivertebra, posterior vertebral column resection",
author = "Chang, {Dong Gune} and Yang, {Jae Hyuk} and Suk, {Se Il} and Seung-Woo Suh and Kim, {Jin Hyok} and Lee, {Seung Joo} and Na, {Ki Ho} and Lee, {Jung Hee}",
year = "2017",
month = "9",
day = "1",
doi = "10.1097/MD.0000000000007746",
language = "English",
volume = "96",
journal = "Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries",
issn = "0025-7974",
publisher = "Lippincott Williams and Wilkins",
number = "36",

}

TY - JOUR

T1 - Fractional curve progression with maintenance of fusion mass in congenital scoliosis

AU - Chang, Dong Gune

AU - Yang, Jae Hyuk

AU - Suk, Se Il

AU - Suh, Seung-Woo

AU - Kim, Jin Hyok

AU - Lee, Seung Joo

AU - Na, Ki Ho

AU - Lee, Jung Hee

PY - 2017/9/1

Y1 - 2017/9/1

N2 - Rationale: The management of congenital scoliosis concentrates on early diagnosis and proper surgical treatment before the development of severe deformities. Decision making regarding the appropriate fusion levels, proper surgical treatment, and reduction amount of kyphoscoliosis is very important but difficult in the treatment of congenital scoliosis, especially in young children. Patient concerns: We report an 11-year follow-up of revision surgery for fractional curve progression after combined anterior and posterior fusion without hemivertebra resection using pedicle screw fixation (PSF) in congenital kyphoscoliosis at age 4 years (a total 18-year follow-up). A T12 hemivertebra was documented in a 4-year-old girl and was treated by combined anterior and posterior fusion in two stages with PSF. The fusion mass was maintained but the distal compensatory curve progressed during the follow-up period. The patient underwent a posterior vertebral column resection (PVCR) with extended posterior fusion at the age of 11, 7 years after initial surgery. Outcomes: Eleven years after the revision surgery with PVCR, the patient showed satisfactory results and her spine was well balanced. Lessons: The cause of revision surgery for the curve progression may include inappropriate fusion level, incomplete hemivertebra resection, or failure of anterior and posterior fusion. Especially, inappropriate fusion level may result in deterioration of the compensatory curve even without progression of the fusion mass. Conclusion: Appropriate selection of fusion levels, complete resection of hemivertebra, and satisfactory reduction of scoliosis and kyphosis are important factors for deformity correction and prevention of progression of both main and compensatory curves (adding-on of structural curve or progression of compensatory curve) as well as reducing the influence of adjacent vertebral growth using as short a fusion as possible.

AB - Rationale: The management of congenital scoliosis concentrates on early diagnosis and proper surgical treatment before the development of severe deformities. Decision making regarding the appropriate fusion levels, proper surgical treatment, and reduction amount of kyphoscoliosis is very important but difficult in the treatment of congenital scoliosis, especially in young children. Patient concerns: We report an 11-year follow-up of revision surgery for fractional curve progression after combined anterior and posterior fusion without hemivertebra resection using pedicle screw fixation (PSF) in congenital kyphoscoliosis at age 4 years (a total 18-year follow-up). A T12 hemivertebra was documented in a 4-year-old girl and was treated by combined anterior and posterior fusion in two stages with PSF. The fusion mass was maintained but the distal compensatory curve progressed during the follow-up period. The patient underwent a posterior vertebral column resection (PVCR) with extended posterior fusion at the age of 11, 7 years after initial surgery. Outcomes: Eleven years after the revision surgery with PVCR, the patient showed satisfactory results and her spine was well balanced. Lessons: The cause of revision surgery for the curve progression may include inappropriate fusion level, incomplete hemivertebra resection, or failure of anterior and posterior fusion. Especially, inappropriate fusion level may result in deterioration of the compensatory curve even without progression of the fusion mass. Conclusion: Appropriate selection of fusion levels, complete resection of hemivertebra, and satisfactory reduction of scoliosis and kyphosis are important factors for deformity correction and prevention of progression of both main and compensatory curves (adding-on of structural curve or progression of compensatory curve) as well as reducing the influence of adjacent vertebral growth using as short a fusion as possible.

KW - congenital scoliosis

KW - curve progression

KW - fusion level

KW - hemivertebra

KW - posterior vertebral column resection

UR - http://www.scopus.com/inward/record.url?scp=85028977345&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85028977345&partnerID=8YFLogxK

U2 - 10.1097/MD.0000000000007746

DO - 10.1097/MD.0000000000007746

M3 - Article

C2 - 28885330

AN - SCOPUS:85028977345

VL - 96

JO - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

JF - Medicine; analytical reviews of general medicine, neurology, psychiatry, dermatology, and pediatries

SN - 0025-7974

IS - 36

M1 - e7746

ER -