- Discussion:
-
progression:
- rt thoracic curves > 50 deg are at highest risk for progression (1 deg/yr) followed by Rt
lumbar curves;
- single thoracic curves> 70-75 deg at growth completion progress an average of about 17 deg;
- high thoracic or cervicothoracic curves usually are of
congenital etiology and rarely are
idiopathic & often produce major deformity;
-
left thoracic scoliosis is rare, and evaluation of spinal cord by MRI, is performed to rule out cord abnormalities;
- PreOp Planning:
- isolated arthrodesis of thoracic curve in
King type II curves may result in
worsening of
lumbar curves postoperatively and loss of balance;
- overcorrection of main thoracic curve may also lead to asymmetric neck and shoulder contour;
- double thoracic curve (
King type V)
- do not assume that the upper (left) thoracic curve is non-structural without proof, and if
there is any question, fuse the upper thoracic spine as well as the lower thoracic spine;
- Choices of Instrumentation:
-
Harrington Instrumentation:
- gold standard for treatment of thoracic idiopathic scoliosis;
-
CD instrumentation:
- may be method of choice for correcting sagittal contour, esp when thoracic spine is hypokyphotic;
- may be used for
double curves and
lumbar curves because it can
restore and preserve the sagittal contour while increasing rigidity;
-
Luque instrumentation: (w/ sublaminar wiring)
- largely has been abandoned for treatment of idiopathic scoliosis due to morbidity and rate of complications;
Scoliosis in children after thoracotomy for aortic coarctation.
