PMC7661020_01
X-ray and 3D-CT images showing the characteristics of the articulation between the spine and the pelvis based on Renshaw type III. a, neutral position; b, manual traction showing a telescoping sign; c: congenitally deformed lower lumbar vertebrae descending into the gap between the bilateral ilia.
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A 10-year-old male with Klippel Feil syndrome had a characteristic telescoping back (Fig. 1).
a: 1-year postoperative X-ray image showing a right rod breakage (white arrowhead); b: X-ray showing posterior fixation with pedicle and iliac screws after removing U.H.U spinal implant; c: CT shows delayed union at the spinopelvic junction after two bone graft augmentations. d: X-ray shows rigid fixation at the pubic symphysis.
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At the 1-year follow-up, the X-ray images revealed rod breakage and screw loosening due to nonunion at the spinopelvic junction (Fig. 2a). Subsequently, because the posterior approach failed to achieve bone union again, bone graft augmentations were performed twice (Fig. 2b). However, bone union at the spinopelvic junction was still not achieved (Fig. 2c). We, therefore, opted for rigid fixation at the pubic symphysis with a small dynamic compression plate (DCP), creating a circumferential fixation of the pelvis (Fig. 2d).
a: Plain X-ray image showing bone union at the spinopelvic junction in an erect position; b, c: CT images showing complete bone union at the spinopelvic junction.
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He maintained an ambulatory status with the support of a single crutch at his final check-up, 8 years postoperatively (Fig. 3).
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a: X-ray images; b: 3D-CT images showing the relation between the congenitally deformed spine and the pelvis (Renshaw type III). White arrowhead indicates a ventriculoperitoneal shunt tube; c: clinical photography.
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A 3-year old boy was referred to our institution with progressive spinal deformity (Fig. 4).
Postoperative plain X-ray images of growth-friendly surgery using VEPTR. a: after index surgery; b: after the fifth extension following replacement.
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We performed growth-friendly surgery using bilateral rib-pelvis devices, vertical expandable prosthetic titanium ribs (VEPTR), following halo-gravity traction at the age of 6 years (Fig. 5a).
a: Plain X-ray images showing rigid fixation at the pubic symphysis combined with posterior fixation of the spinopelvic junction; b: CT images showing complete bone union at the spinopelvic junction.
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Because of unreliable stability on the distal anchor fixation, we planned and performed additional fixation at the pubic symphysis with a small DCP 1 month after the posterior fixation (Fig. 6a), followed by posterior augmentation with an allograft. These multiple procedures to create a rigid stabilization of the pelvic ring enabled complete bone union at the spinopelvic junction within a year of the operation (Fig. 6b).