Surgical treatment of advanced congenital kyphoscoliosis: A case report

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Abstract

Clinical case of surgical treatment of advanced congenital kyphoscoliosis in 12 years old child is reported. Radiographs and CT at presentation failed to reveal the entire anomaly. By analysis of priorly made radiographs hemivertebra L1 was recognized. At genitourinary assessment L-shaped kidney was detected. A full-size 3D-printed model was used for surgical planning. Vertebral column resection as treatment option was discussed, but due to high neurologic complication rate this approach was refused. After preoperative 35 days halo-femoral traction anterior instrumented fusion was performed. Right ureter was stented for intraoperative urologic injury prevention. Scoliosis correction of 32% and kyphosis of 14% was achieved. 5 months later definitive posterior uninstrumented fusion was performed. Spinal deformities caused by vertebral malformations progress dramatically unless they are treated early. An advanced case is a clinical challenge because of technical difficulties and poor result. Vertebral column resection is a treatment option for severe kyphoscoliosis, but it’s indications should be strictly individualized. Preoperative halo-femoral traction is the most safe correction method in spinal deformity due to prolonged and gradual action. 3d-printed models are practical for surgical planning. The model may be used intraoperatively as a 3D-reference. In congenital scoliosis genitourinary system should be assessed meticulously, and urologist advice in relevant case is necessary.

About the authors

Artem V. Kosulin

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: hackenlad@mail.ru

Assistant Professor, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Dmitriy V. Elyakin

St. Petersburg State Pediatric Medical University

Email: dimaelkins@mail.ru

Pediatric Surgeon, Surgical Department No 2

Russian Federation, Saint Petersburg

Nadezhda N. Dmitrieva

St. Petersburg State Pediatric Medical University

Email: nadegdanik86@gmail.com

Resident Doctor, Department of Surgical Diseases of Childhood

Russian Federation, Saint Petersburg

Alina D. Abzalieva

St. Petersburg State Pediatric Medical University

Email: a.abzalieva@gmail.com

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Aleksandra A. Blazhenko

St. Petersburg State Pediatric Medical University

Email: alexandrablazhenko@gmail.com

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Lyubov V. Volchenko

St. Petersburg State Pediatric Medical University

Email: volchenko.lyubov@mail.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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2. Fig. 1. Computed tomography at presentation (age 12 years old)

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3. Fig. 2. Radiographs at age 5 months old

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4. Fig. 3. Radiographs at age 1 year 7 months old

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5. Fig. 4. 3D-printed model of the malformation region

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6. Fig. 5. Radiographs at 5 months postoperative follow up

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Copyright (c) 2018 Kosulin A.V., Elyakin D.V., Dmitrieva N.N., Abzalieva A.D., Blazhenko A.A., Volchenko L.V.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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