PMC7447341_01
A four-year-old girl with severe kyphoscoliosis due to spondylo-epi-metaphyseal dysplasia (SEMD) with joint laxity. A) Cobb angles of thoracic (T1-T8) and thoracolumbar scoliosis (T8-L4) are 76 and 126 degrees, respectively. B) There is severe thoracic lordosis (T1-T8, -69 degrees) and severe thoracolumbar kyphosis (T8-L3, 98 degrees). Minus sign indicates lordosis.
2432-261X-4-0284-g001.jpg
PMC7447341_01_2432-261X-4-0284-g001.jpg
g001
Initial radiography showed 76  thoracic scoliosis, 126  thoracolumbar scoliosis, 69  thoracic lordosis and 98  thoracolumbar kyphosis (Fig. 1).
Our unique strategy for growing rod (GR) treatment: prior foundation surgery (PFS). A, B) Posterior fusion at the proximal (T3-T4) and distal (L3-L4) foundation sites was performed before the initial rod placement. C) Four months later, solid posterior arthrodesis was completed at the proximal foundation site. D) Immediately after the initial corrective procedure with rod placement, thoracic (T1-T8) and thoracolumbar scoliosis (T8-L4) were corrected to 37 and 57 degrees, respectively. Correction rates of the major curves after initial corrective surgery were seen at 51% and 55%, respectively. E) The sagittal Cobb angles of T5-T12 and T12-S1 have been corrected to 13 and -5 degrees, respectively.
2432-261X-4-0284-g002.jpg
PMC7447341_01_2432-261X-4-0284-g002.jpg
g002
One-level posterior fusion at the proximal (T3-T4) and distal (L3-L4) anchor sites was performed, i.e., prior foundation surgery (PFS) (Fig. 2). At the time of GR placement (four months after PFS), consolidation was confirmed at each fusion level (Fig. 2C).
A, B) To correct and prevent flat-back deformity caused by repeated distraction-based procedures, anterior spinal fusion from L2 to L4 is carried out six years after the index surgery.
2432-261X-4-0284-g003.jpg
PMC7447341_01_2432-261X-4-0284-g003.jpg
g003
To prevent further flat-back deformity, anterior spinal fusion from L2 to L4 was carried out six years after the index surgery (Fig. 3).
Whole-spine standing X-ray two years after definitive fusion (14 years old). A) Cobb angles of the thoracic and thoracolumbar scoliotic curvatures are 38 and 33 degrees, respectively. B) The sagittal Cobb angles of T5-T12 and T12-S1 are 14 and -29 degrees, respectively.
2432-261X-4-0284-g004.jpg
PMC7447341_01_2432-261X-4-0284-g004.jpg
g004
The final, follow-up radiograph demonstrated 38  thoracic scoliosis, 33  thoracolumbar scoliosis, 14  thoracic kyphosis and 29  lumbar lordosis (Fig. 4).