Surgical treatment for congenital scoliosis: biconcave uninstrumented poster fusion
DOI:
https://doi.org/10.31282/joti.v3n2.56Keywords:
Congenital scoliosis, posterior fusionAbstract
Introduction: Congenital scoliosis is rare to find, and the treatment modalities are scarce and highly debatable. The goals of surgery are to arrest progression while maintaining a globally balanced spine and maximizing the potential for further growth. Although conservative approach is preferable, there are also proposed decisions for much aggressive managements.
Case Report: We present a case of a 2-year-old girl with congenital scoliosis. With severe angle and symptoms developing from the deformity starting to take its toll, interventive treatment was indicated. A two-level biconcave, uninstrumented, posterior fusion was performed, together with bracing to complete the treatment. The deformity was corrected acutely. The patient was able to return to normal activities one week after the surgery. Although longer follow up should be done, this, however, could not be fulfilled because of the patient’s incompliance. The main striking drawback of instrumentation is the growing ability, as the characteristic of a child itself is growing. The child might outgrow the instrument over time. Thus, a staged approach should be done. A non-instrumentation procedure was performed, and bracing was originally taken to keep the curvature at bay.
Conclusion: Children are much more prone to changes and this proneness to changes might as well be considered in the treatment. Thus, staged approach and careful monitor of growth is mandatory.
Downloads
References
Birnbaum K, Weber M, Lorani A, Leiser-Neef U, Niethard FU. Prognostic significance of the Nasca classification for the long-term course of congenital scoliosis. Arch Orthop Trauma Surg. 2002;122(7):383–9.
Wynne Davies R. Congenital vertebral anomalies: aetiology and relationship to spina bifida cystica. J Med Genet. 1975;12(3):280–8.
Giampietro PF, Raggio CL, Blank RD, McCarty C, Broeckel U, Pickart MA. Clinical, genetic and environmental factors associated with congenital vertebral malformations. Mol Syndromol. 2013;4(1–2):94–105.
McMaster MJ, Ohtsuka K. The natural history of congenital scoliosis. A study of two hundred and fifty-one patients. J Bone Jt Surg - Ser A. 1982;64(8):1128–47.
Prahinski JR, Polly DW, McHale KA, Ellenbogen RG. Occult intraspinal anomalies in congenital scoliosis. J Pediatr Orthop. 2000;20(1):59–63.
Hensinger RN. Congenital scoliosis: Etiology and associations. Spine (Phila Pa 1976). 2009;34(17):1745–50.
Marks DS, Qaimkhani SA. The natural history of congenital scoliosis and kyphosis. Spine (Phila Pa 1976). 2009;34(17):1751–5.
Repko M, Krbec M, Burda J, Pešek J, Chaloupka R, Tichý V, et al. Simple bony fusion or instrumented hemivertebra excision in the surgical treatment of congenital scoliosis. Acta Chir Orthop Traumatol Cech. 2008;75(3):180–4.
Ghiță RA, Georgescu I, Muntean ML, Hamei S, Japie EM, Dughilă C, et al. Burnei-Gavriliu classification of congenital scoliosis. J Med Life. 2015;8(2):239–44.
Hedequist D, Emans J. Congenital scoliosis. J Am Acad Orthop Surg. 2004;12(4):266–75.
Thompson AG, Marks DS, Sayampanathan SRE, Piggott H. Long-term results of combined anterior and posterior convex epiphysiodesis for congenital scoliosis due to hemivertebrae. Spine (Phila Pa 1976). 1995;20(12):1380–5.
Chang DG, Kim JH, Ha KY, Lee JS, Jang JS, Suk S Il. Posterior Hemivertebra Resection and Short Segment Fusion with Pedicle Screw Fixation for Congenital Scoliosis in Children Younger Than 10 Years: Greater Than 7-Year Follow-up. Spine (Phila Pa 1976). 2015;40(8):E484–91.
Campbell RM, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Jt Surg - Ser A. 2003;85(3):399–408.
Flynn JM, Tomlinson LA, Pawelek J, Thompson GH, McCarthy R, Akbarnia BA. Growing-rod graduates: Lessons learned from ninety-nine patients who completed lengthening. J Bone Jt Surg - Ser A. 2013;95(19):1745–50.
Cheung KMC, Cheung JPY, Samartzis D, Mak KC, Wong YW, Cheung WY, et al. Magnetically controlled growing rods for severe spinal curvature in young children: A prospective case series. Lancet. 2012;379(9830):1967–74.
