1
|
Wu H, Ding J, Yang J, Sui W. Postoperative dysesthesia after PVCR without anterior support applied in Yang's type A severe spinal kyphoscoliosis. Front Surg 2023; 10:1222520. [PMID: 37538390 PMCID: PMC10394467 DOI: 10.3389/fsurg.2023.1222520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/03/2023] [Indexed: 08/05/2023] Open
Abstract
Backgrounds The incidence and characteristics of postoperative dysesthesia (POD) have not been reported for posterior vertebral column resection (PVCR) in the treatment of severe spinal kyphoscoliosis. Objective The objective of the study is to investigate the incidence and characteristics of POD in PVCR without anterior support applied in Yang's type A severe spinal kyphoscoliosis. Material and methods From August 2010 to December 2019, 167 patients diagnosed with Yang's type A severe spinal kyphoscoliosis who underwent PVCR without anterior support applied were retrospectively reviewed. All the patients were monitored using five modes of intraoperative multimodal neurophysiological monitoring. Neuromonitoring data, radiographic parameters, and neurological complications were reviewed and analyzed. The incidence and characteristics of POD were further summarized. POD was defined as dysesthetic pain or burning dysesthesia which could be caused by spinal cord kinking or dorsal root ganglion (DRG) injury but with no motor deficits. Results PVCR without anterior support was successfully conducted in all 167 patients. Intraoperative monitoring events occurred in five patients. One out of these five patients showed postoperative spinal cord injury (Frankel level C) but completely recovered within 9 months postoperation (Frankel level E). The number of levels and osteotomy space for vertebra resection were 1.28 and 3.6 cm, respectively. POD was confirmed in three patients (3/167, 1.8%), characterized as kyphosis with the apex vertebrae in T12 with the kyphotic Cobb angles of 100°, 115°, and 122°, respectively. The osteotomy space of vertebra resection in these three patients were 3.9, 3.8, and 4.2 cm, respectively. After the treatment by drug administration, they reported pain relief for 12-36 days. The pain gradually moved to the distal end of a proper DRG innervated region near the end. Conclusions In this study, the incidence rate of POD in Yang's type A severe spinal kyphoscoliosis patients who underwent PVCR without anterior support applied was 1.8% (3/167). Evoked potential monitoring could not detect the occurrence of POD. POD in Yang's type A severe spinal kyphoscoliosis after PVCR could be ascribed to spinal cord kinking and DRG injury.
Collapse
Affiliation(s)
- Hangqin Wu
- Department of Orthopaedic Surgery, Wuyi County First People's Hospital, Zhejiang, China
| | - Jie Ding
- Department of Orthopaedic Surgery, Changxing People's Hospital of Chongming District, Shanghai, China
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
2
|
Zhang Z, Song Z, Yang X, Li T, Bi N, Wang Y. Is There a Correlation Between Cobb Angle and Pulmonary Function Tests at 2-year Follow-up in Patients With Severe Spinal Deformity Treated by Posterior Vertebral Column Resection? Clin Spine Surg 2022; 35:E483-E489. [PMID: 34907929 PMCID: PMC9162077 DOI: 10.1097/bsd.0000000000001284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/11/2021] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE The aim was to evaluate the relationships of Cobb angle and pulmonary function tests (PFTs) changes in severe spinal deformity and underwent posterior vertebral column resection (PVCR). SUMMARY OF BACKGROUND DATA No previous study focused on the correlation of deformity correction and PFTs changes in patients with cobb angle >90 degrees. METHODS PFTs values [forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), and percent-predicted values FVC%, FEV1%] were evaluated preoperative and at 2 years after PVCR. FVC% <80% were defined as restrictive ventilation dysfunction (RVD), the severity of RVD were divided into mild (FEV1% ≥70%), moderate (70% > FEV1% ≥50%) and severe (FEV1% <50%). The relationships among PFTs values improvements and all possible impact factors (mainly correction cobb angle) collected in this study were analyzed. PFTs data were compared among the 3 RVD subgroups (mild vs. moderate vs. severe) and between residual >30 versus <30 degrees. RESULTS A total of 53 cases (28 male/25 female, mean ages 18.9 Y) underwent PVCR in one center from 2004 to 2016 were enrolled cobb angle. When 2 years after PVCR, average PFTs values showed significant improvements. PFTs values changes showed no correlation with correction rate and correction angle. The only significant impact factor in this study for FVC, FVC%, FEV1 improvements was preoperative FVC% and the only impact factor for FEV1% improvement was preoperative FEV1%, the relationships were negative. In accordance with the regression analysis, PFTs values improvements among the 3 RVD subgroups from high to low was severe>moderate>mild. However, patients with residual cobb angle <30 degrees had less PFTs values improvements than patients with residual cobb angle >30 degrees. CONCLUSIONS Two years after PVCR, PFTs values were significantly improved. There is no linear correlation between cobb angle change and PFTs values improvements. Lower preoperative FVC% and FEV1% indicate more PFTs values improvements at 2 years post-PVCR. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Zhaoquan Zhang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhibo Song
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiaochen Yang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Li
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ni Bi
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yingsong Wang
- Department of Orthopaedics of Second Affiliated Hospital of Kunming Medical University, Kunming, China
| |
Collapse
|
3
|
Xue R, Liu D, Shen Y. Comparison of Posterior Unilateral Vertebral Column Resection Versus Posterior Vertebral Column Resection for Severe Thoracolumbar Angular Kyphosis as a Revision Surgical Modality: A Retrospective Cohort Study. Clin Spine Surg 2021; 34:E303-E307. [PMID: 33323700 PMCID: PMC8168930 DOI: 10.1097/bsd.0000000000001123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine the safety and efficacy of posterior unilateral vertebral column resection (PUVCR) as revision surgery for severe thoracolumbar angular kyphosis. PATIENTS AND METHODS This is a retrospective cohort study. Adult patients undergoing revision surgery for severe thoracolumbar angular kyphosis in 2010-2016 with ≥2-year follow-up at our institution were assessed. Perioperative complications and clinical outcomes, including blood loss, operation time, Visual Analog Scale score, Oswestry Disability Index, and preoperative and postoperative kyphotic angles, were analyzed. RESULTS This study included 58 patients who were divided into the PUVCR group and the posterior vertebral column resection (PVCR) group. Age ( P =0.810), sex distribution ( P =0.500), and vertebrae that underwent surgery ( P =0.638) were similar in the 2 groups. Shorter mean operation time was observed in the PUVCR group as compared with the PVCR group ( P <0.001). In addition, less blood loss was recorded in the PUVCR group as compared with the PVCR group ( P =0.001). There were no significant differences between the 2 groups in a change of Visual Analog Scale scores postoperation versus preoperation ( P =0.961), and at postoperative 3 months ( P =0.906), 12 months ( P =0.752), and 24 months ( P =0.811) versus postoperation, respectively. There were no significant differences between the 2 groups in Oswestry Disability Index changes postoperation versus preoperation ( P =0.157), and at postoperative 3 months ( P =0.899), 12 months ( P =0.947), and 24 months ( P =0.811) versus postoperation, respectively. PUVCR and PVCR were comparable in deformity correction ( P =0.434) and final angle correction ( P =0.790). Complication rates in the PUVCR and PVCR groups were 7.1% and 36.7%, respectively. CONCLUSION PUVCR has comparable safety and efficacy to PVCR in treating severe thoracolumbar angular kyphosis, with the advantages of the shorter operation time, less blood loss, and fewer complications.
Collapse
Affiliation(s)
| | - Dai Liu
- Rehabilitation Office, The Third Hospital of HeBei Medical University, Shi Jiazhuang, China
| | | |
Collapse
|
4
|
Li T, Zhao Z, Wang Y, Xie J, Zhang Y, Bi N, Shi Z, Lu Q, Li Q. A preliminary study of spinal cord blood flow during PVCR with spinal column shortening: A prospective clinic study in severe rigid scoliokyphosis patients. Medicine (Baltimore) 2020; 99:e21579. [PMID: 32769906 PMCID: PMC7593061 DOI: 10.1097/md.0000000000021579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Posterior vertebral column resection (PVCR) was the most powerful technique for treating severe rigid spinal deformity, but it has been plagued with high neurologic deficits risk. The fluctuations of spinal cord blood flow (SCBF) play an important role in secondary spinal cord injury during deformity correction surgery.The objective of this study was to first provide the characteristic of SCBF during PVCR with spinal column shortening in severe rigid spinal deformity.Severe rigid scoliokyphosis patients received PVCR above L1 level were included in this prospective study. Patients with simple kyphosis, intraspinal pathology and any degree of neurologic deficits were excluded. The deformity correction was based on spinal column shortening over the resected gap during PVCR. Laser Doppler flowmetry was used to monitor the SCBF at different surgical stages.There were 12 severe rigid scoliokyphosis patients in the study. The baseline SCBF was 316 ± 86 perfusion unite (PU), and the SCBF decreased to 228 ± 68 PU after VCR (P = .008). The SCBF increased to 296 ± 102 PU after the middle shortening and correction which has a 121% increased comparison to the SCBF after VCR (P = .02). The SCBF will slightly decrease to 271 ± 65 PU at final fixation. The postoperative neural physical examination of all patients was negative, and the MEP and SSEP of all patients did not reach the alarm value during surgery.These results indicate that PVCR is accompanied by a change in SCBF, a proper spinal cord shortening can protect the SCBF and can prevent a secondary spinal cord injury during the surgery.
Collapse
|
5
|
Lee BH, Hyun SJ, Han S, Kim KJ, Jahng TA, Kim YJ, Kim HJ. Surgical and radiological outcomes after posterior vertebral column resection according to the surgeon's experience. Medicine (Baltimore) 2018; 97:e11660. [PMID: 30142756 PMCID: PMC6112904 DOI: 10.1097/md.0000000000011660] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to estimate and analyze the radiological, surgical, and clinical results of posterior vertebral column resection (PVCR) according to the surgeon's experience. Although PVCR has been recognized as the most powerful surgical technique to correct severe spinal deformity, PVCR is a technically demanding procedure with a high complication rate. A retrospective review of the chart and radiographic data of 34 consecutive patients who received PVCR was carried out. According to the time period, the former and latter 17 patients were divided into group 1 and group 2, respectively. Patients' demographics, surgical, radiological/clinical outcomes, and complications were compared between the groups. The demographic data of the patients had no significant difference between the groups. The surgical time (492.5 ± 164.8 vs 350.5 ± 133.9 minutes, P = .010), estimated blood loss (1294.1 ± 711.9 vs 974.1 ± 905.9 mL, P = .045), and length of hospital stay (22.8 ± 12.9 vs 13.4 ± 3.9 days, P = .017) were significantly reduced in group 2. The correction of the PVCR site (40.5° ± 13.3° vs 41.2° ± 23.7°, P = .909), sagittal vertical axis (SVA, 81.9 ± 7.2 mm vs 77.9 ± 102.0 mm, P = .904) were not different between the groups. The total number of complications (22 vs 10, P = .031) and patients having complications (13 vs 7, P = .039) were lower in group 2. Additional surgery was significantly lower in group 2 (13 vs 3, P = .007). The clinical outcomes by revised Scoliosis Research Society-22 (SRS-22r) questionnaire were not different between the groups. Our series revealed that the complications after PVCR may reduce from 17 cases and surgical outcomes might be stabilized by 29 cases.
Collapse
Affiliation(s)
- Byoung Hun Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Sanghyun Han
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Yongjung J. Kim
- Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons, NY, USA
| | - Hyun-Jib Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
6
|
Abstract
STUDY DESIGN Consecutive, retrospective review. OBJECTIVES To evaluate and report a modified posterior vertebral column technique. METHODS We present a retrospective analysis of 20 patients. Patients having severe 3-dimensional deformity with flexibility less than 20% and managed by posterior vertebral body resection (PVCR) between 2011 and 2014 were included in this study. There were 12 female and 8 male patients, with a mean age of 18 year (range = 3-63 years). RESULTS The average follow-up was 3.5 years (2-5 years). The preoperative coronal plane deformity was 84° (70° to 120°) and corrected to 42° (28° to 68°), showing 60% scoliosis correction. Average preoperative local kyphotic angle was 92° (82° to 110°). Correction rate for kyphosis was 62%. All patients after surgery showed their baseline neurological status, and no complications were encountered. The mean estimated blood loss was 1072 mL (350-2000 mL). Thirty-nine percent (33% to 50%) of total blood loss occurred after vertebral body resection, and 61% (50% to 67%) blood loss occurred after the removal of posterior elements. The ratio of estimated blood loss to estimated body blood volume was 26% (range = 19% to 52%). CONCLUSION We found that 60% of total bleeding occurs during and after posterior bone resection. Spinal cord is open to possible iatrogenic direct spinal cord injury with surgical instruments for a much shorter period of time compared with the original technique.
Collapse
Affiliation(s)
- Ufuk Aydinli
- Verom Spine and Tumor Center, Bursa, Turkey,Ufuk Aydinli, Verom Spine and Tumor Center, Mediloft
21. Sedir sok 1-5 D:6, Baglarbasi mah., Osmangazi, Bursa 16080, Turkey.
| | - Kursat Kara
- İstinye University Medical School, Istanbul, Turkey
| | | | | |
Collapse
|
7
|
Chang DG, Yang JH, Suk SI, Suh SW, Kim JH, Lee SJ, Na KH, Lee JH. Fractional curve progression with maintenance of fusion mass in congenital scoliosis: An 18-year follow-up of a case report. Medicine (Baltimore) 2017; 96:e7746. [PMID: 28885330 PMCID: PMC6393091 DOI: 10.1097/md.0000000000007746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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.
Collapse
Affiliation(s)
- Dong-Gune Chang
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Se-Il Suk
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Seung-Woo Suh
- Department of Orthopedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Jin-Hyok Kim
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Seung-Joo Lee
- Department of Orthopedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Ki-Ho Na
- Department of Orthopedic Surgery, St. Paul's Hospital, College of Medicine, Catholic University of Korea
| | - Jung-Hee Lee
- Department of Orthopedic Surgery, Kyung Hee Hospital, College of Medicine, Kyung Hee University, Seoul, Korea
| |
Collapse
|
8
|
Tao Y, Wu J, Ma H. Posterior-only vertebral column resection for revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia: A case report and literature review. Medicine (Baltimore) 2017; 96:e5690. [PMID: 28072705 PMCID: PMC5228665 DOI: 10.1097/md.0000000000005690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Severe post-laminectomy spinal deformity associated with late-onset paraplegia is a complex and rare disorder. Little is known about revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia treated by the single stage posterior-only vertebral column resection (VCR) procedure. PATIENT CONCERNS AND DIAGNOSES The patient was a 14-year-old male diagnosed as post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia. He underwent posterior total laminectomy through the thoracic spine for intramedullary spinal cord tumors at the age of 3 years in another hospital. He then developed kyphosis deformity 1 year after laminectomy, and underwent posterior spinal fusion without instrumentation at 9 years of age. However, the deformity gradually progressed over the years. Seven months before admission to our hospital, he developed a significant progression of neurological deficits, including weakness of strength and sensation in lower extremities bilaterally, with no bladder or bowel dysfunction. There was no improvement of spinal cord function with conservative measures, and he required a wheelchair for movement. INTERVENTIONS The patient underwent posterior-only VCR by single stage with the purposes of spinal cord decompression and spinal deformity correction. OUTCOMES Postoperatively, he was transferred to the intensive care unit (ICU) and required positive pressure ventilation support to improve his respiratory condition. The child experienced cerebrospinal fluid leak (CSF) which resulted in an unplanned return to the operating room. The neurological function improved from preoperative Frankel C to Frankel D within 12 months of surgery, and recovered completely to Frankel E by 18 months. At the 24 month follow-up, the good neurological function was maintained; pulmonary function tests (PFTs) revealed improved forced vital capacity (FVC) and forced expiratory volume for 1 second (FEV1). The patient's coronal major curve and sagittal kyphosis were corrected from 70° to 21°, and 170° to 75°, respectively. LESSONS These findings demonstrated that single-stage posterior-only VCR is efficacious but challenging for revision surgery in post-laminectomy rotokyphoscoliosis associated with late-onset paraplegia.
Collapse
|
9
|
Chang DG, Yang JH, Lee JH, Lee JS, Suh SW, Kim JH, Oh SY, Cho W, Park JB, Suk SI. 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. Medicine (Baltimore) 2016; 95:e5266. [PMID: 27893663 PMCID: PMC5134856 DOI: 10.1097/md.0000000000005266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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.
Collapse
Affiliation(s)
- Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Jung-Hee Lee
- Department of Orthopaedic Surgery, Kyung Hee Hospital, College of Medicine, Kyung Hee University
| | - Jung-Sub Lee
- Department of Orthopaedic Surgery, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea
| | - Seung-Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University
| | - Jin-Hyok Kim
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Seung-Yeol Oh
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Woojin Cho
- Department of Orthopaedic Surgery, The University Hospital for Albert Einstein College of Medicine, Albert Einstein College of Medicine, New York, NY
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Se-Il Suk
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| |
Collapse
|