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 language | English |
|---|---|
| Article number | e7746 |
| Journal | Medicine (United States) |
| Volume | 96 |
| Issue number | 36 |
| DOIs | |
| Publication status | Published - 2017 Sep 1 |
Fingerprint
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 journal › Article
}
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 -