tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 72

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 72. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Congenital Scoliosis Chapter 25 703 Case Study 1 A3-year-old boy presented forevaluation and management of a progressive congenital scoliosis. He was diagnosed with a cardiac murmur at birth and subsequent echocardiogram revealed severe congenital cardiomyopathy and pulmonary hypertension that eventually required surgical intervention. AP and lateral radiographs a b of the spine reveal a partially segmented incarcerated hemivertebra at the thoracolumbar junction. Cobb angle measured from endplate to endplate was 37 degrees at the time of surgery. Physical examination and MRI revealed no other neurologic findings. The patient underwent an anterior hemiepiphysiodesis and posterior hemiarthrodesis on the convex side of the curve c . Segmental vessels were ligated with surgical clips. The intervertebral disc and therefore the growth potential on the concave side of the curve were left intact. The patient tolerated the procedure well and achieved a solid arthrodesis on the convexity of the curve. The remaining growth potential produced unilateral growth and progressive correction of the curve. At latest follow-up d e the congenital curve had been reduced to 20 degrees over a 5-year period. 704 Section Spinal Deformities and Malformations Case Study 2 A 14-year-old male with congenital scoliosis presented with a 55-degree upper left thoracic curve. He was otherwise neurologically intact. There were no other members in his family with scoliosis. The remaining medical work-up and MRI was negative for associated cardiac genitourinary or neurologic malformations. Because of the location of the congenital anomaly in the high thoracic spine the patient developed a fairly dramatic clinical deformity with an elevated left shoulder a b and coronal imbalance c . As a result he underwent an instrumented posterior spinal fusion. Intraope-ratively the left convex rod was inserted first and a compression maneuver performed. The second concave rod was placed in situ with minimal .