|
Year |
2003 |
|---|---|
|
Question Number |
144 |
|
Category |
Pediatric Orthopaedics |
Question
A 3-year-old girl has a left thoracolumbar scoliosis measuring 40 degrees that has progressed 12 degrees in the past year. Neurologic examination is intact. Radiographs show a hemivertebra at T12, with a contralateral bar from T11 to L1. Based on these findings, what is the best course of action?
1- Brace treatment to prevent development of compensatory curves
2- In situ anterior and posterior fusion
3- Anterior fusion
4- Posterior fusion with a "growth rods" technique
5- Excision of the congential bar
Figures
Answer (click for answer)
Preferred answer 2
Congenital scoliosis caused by a unilateral unsegmented bar has a bad prognosis. However, there is a smaller less well-recognized group of patients who, in addition to a unilateral unsegmented bar, have one or more hemivertebrae on the contralateral side of the spine at the same level; and they have a worse prognosis. These patients have some of the severest deformities seen by the spine surgeon. These patients have the most rapidly progressive and severely deforming of all types of congenital scoliosis. All midthoracic, thoracolumbar, and lumbar curves require immediate prophylactic surgical treatment by anterior AND posterior arthrodesis-preferably in the first year of life.
Reference: McMaster MJ: Congenital scoliosis caused by unilateral failure of
vertebral segmentation with contralateral hemivertebra. Spine
1998;23:998-1005.
Holte DC, Winter RB, Lonstein JE, Denis F: Excision of
Hemivertebrae and wedge resection in the treatment of congenital
Scoliosis. J Bone Joint Surg Am 1995;77:159-171.