Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis A case report

Dong Gune Chang, Jae Hyuk Yang, Jung Hee Lee, Jung Sub Lee, Seung-Woo Suh, Jin Hyok Kim, Seung Yeol Oh, Woojin Cho, Jong Beom Park, Se Il Suk

Research output: Contribution to journalArticle

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Abstract

Rationale: Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity. Patient concerns:We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27 (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30 with fast progression. This includes documented progression of the curve by more than 5 in a 6-month period, failure of conservative treatment, or both. Outcomes: The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced. Lessons: This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary. Conclusion: Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up.

Original languageEnglish
Article numbere5266
JournalMedicine (United States)
Volume95
Issue number47
DOIs
Publication statusPublished - 2016

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Scoliosis
Reoperation
Spine
Therapeutics
Early Diagnosis
Pain

Keywords

  • Congenital scoliosis
  • Hemivertebra
  • Implant removal
  • Posterior fusion
  • Posterior vertebral column resection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis A case report. / Chang, Dong Gune; Yang, Jae Hyuk; Lee, Jung Hee; Lee, Jung Sub; Suh, Seung-Woo; Kim, Jin Hyok; Oh, Seung Yeol; Cho, Woojin; Park, Jong Beom; Suk, Se Il.

In: Medicine (United States), Vol. 95, No. 47, e5266, 2016.

Research output: Contribution to journalArticle

Chang, Dong Gune ; Yang, Jae Hyuk ; Lee, Jung Hee ; Lee, Jung Sub ; Suh, Seung-Woo ; Kim, Jin Hyok ; Oh, Seung Yeol ; Cho, Woojin ; Park, Jong Beom ; Suk, Se Il. / Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis A case report. In: Medicine (United States). 2016 ; Vol. 95, No. 47.
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abstract = "Rationale: Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity. Patient concerns:We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27 (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30 with fast progression. This includes documented progression of the curve by more than 5 in a 6-month period, failure of conservative treatment, or both. Outcomes: The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced. Lessons: This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary. Conclusion: Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up.",
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AU - Chang, Dong Gune

AU - Yang, Jae Hyuk

AU - Lee, Jung Hee

AU - Lee, Jung Sub

AU - Suh, Seung-Woo

AU - Kim, Jin Hyok

AU - Oh, Seung Yeol

AU - Cho, Woojin

AU - Park, Jong Beom

AU - Suk, Se Il

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AB - Rationale: Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity. Patient concerns:We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27 (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30 with fast progression. This includes documented progression of the curve by more than 5 in a 6-month period, failure of conservative treatment, or both. Outcomes: The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced. Lessons: This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary. Conclusion: Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up.

KW - Congenital scoliosis

KW - Hemivertebra

KW - Implant removal

KW - Posterior fusion

KW - Posterior vertebral column resection

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