Failed Primary Surgery in Congenital Scoliosis Caused by a Single Hemivertebra: Reasons and Revision Strategies

Progressive coronal caudal curve after corrective osteotomies for congenital cervicothoracic scoliosis: incidence and predictors

OBJECTIVE

Postoperative progressive coronal caudal curve (PCC) was characterized by a postoperative de novo caudal S-curve ≥ 20° following congenital cervicothoracic scoliosis (CTS) corrective osteotomies, and at least 20° greater than the preoperative measurement, while the incidence was uncertain and the pathogenesis was equivocal. The objective of this study was to investigate the morbidity and potential factors contributing to PCC following CTS surgery.

METHODS

This study reviewed 72 CTS patients between 2005 and 2021. Patients were categorized into two groups according to the absence or presence of PCC at last follow-up, namely the nonprogressive curve group (NPC-group) and the progressive curve group (PC-group). Demographics, radiographic data and the Scoliosis Research Society-22 (SRS-22) questionnaire results were reviewed. Multivariate linear regression analyses were utilized to determine possible predictors for PCC.

RESULTS

PCC was observed in 11 (15%) of the total 72 patients. Compared with the NPC-group, the PC-group exhibited greater postoperative residual local curve (24.0 ± 9.7° vs. 9.1 ± 4.4°, P < 0.001), upper instrumented vertebra (UIV) tilt (16.9 ± 7.4° vs. 6.2 ± 3.7°, P < 0.001), T1 tilt (14.3 ± 9.4° vs. 6.6 ± 3.9°, P = 0.022) and neck tilt (10.1 ± 6.7° vs. 3.7 ± 2.5, P = 0.009). The multivariable linear regression demonstrated that the larger postoperative UIV tilt, residual local curve and neck tilt were associated with PCC. In addition, patients with PCC showed lower SRS-22 scores in terms of pain, mental health, self-image and satisfaction (P < 0.05).

CONCLUSIONS

The morbidity of PCC was 15% in CTS patients who underwent corrective osteotomies. Greater residual local curve, postoperative UIV tilt and neck tilt were identified as predictors for PCC.

Multilevel Customized 3D-Printed Titanium Alloy Interbody Cages used to Treat Congenital Scoliosis: A Case Report

Introduction

Customized, patient-specific interbody cages have been used in the treatment of spinal neoplasia, degenerative disease, infection, congenital anomalies, and trauma. However, to date, their use has been limited to a single spinal level, and the utility of customized spinal implants in multiple spinal levels remains unclear. In addition, limited studies exist that compare outcomes following fusion and decompression surgery using customized implants to traditional, standard implants.

Case Report

We present two cases. Case 1 consists of a multilevel deformity surgery from L3-S1 ALIF and T10-Pelvis PSF in a patient with a congenital scoliosis (CS) using customized implants on multiple spinal levels. We compare Case 1 to Case 2, in which a patient underwent a lumbar decompression and fusion for CS using standard titanium implants. While the patient in Case 1 reported improved back pain and independent ambulation at 1-year post-operative and required no revision surgery, the patient in Case 2 required revision surgery 2 years post-operative due to pseudoarthrosis.

Conclusion

CS with right wedge hemivertebrae may be treated with customized implants on multiple spinal levels, and customized implants may provide benefit standard implants.