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Fractional curve progression with maintenance of fusion mass in congenital scoliosis: An 18-year follow-up of a case report.

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.

journal_name

Medicine (Baltimore)

journal_title

Medicine

authors

Chang DG,Yang JH,Suk SI,Suh SW,Kim JH,Lee SJ,Na KH,Lee JH

doi

10.1097/MD.0000000000007746

subject

Has Abstract

pub_date

2017-09-01 00:00:00

pages

e7746

issue

eissn

0025-7974

issn

1536-5964

pii

00005792-201709080-00010

journal_volume

pub_type

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Fractional curve progression with maintenance of fusion mass in congenital scoliosis: An 18-year follow-up of a case report.