PMC3766212_01
Standing radiographs. (A) Radiographs before initial surgery. (B) Radiographs 3 years after initial surgery.
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F1
The right thoracic Cobb angle was 56  (T6-T12), with a nonstructural left lumbar curve of 23  before her initial surgery (Figure 1A). At the time of examination just prior to the planned implant removal, her Cobb angle was noted to have increased 5, to 29  (T6-T12) (Figure 1B).
Standing radiographs. (A) Radiographs 1 month after implant removal. (B) Radiographs 18 months after implant removal.
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F2
One month after removal, her right thoracic curve was 33 , representing an additional 4  loss of correction (Figure 2A). The kyphosis between T5 and T12 also had increased, from 45  to 62  (Figure 2B).
Bending radiograph prior to reinstrumentation.
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F3
On examination, the thoracic curve demonstrated minimal flexibility on preoperative bending films (Figure 3).
Three-dimensional computed tomography (CT) image prior to reinstrumentation.
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F4
Preoperative three-dimensional CT scanning revealed partial clefts between T11 and T12, but the CT images were inconclusive as to whether the fusion mass had a complete lack in continuity or non-union (Figure 4).
Operative photographs. Intraoperative view (A) before osteotomies and (B) after osteotomies.
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F5
During the third operation, the fusion mass was completely exposed and explored (Figure 5).
Radiographs after reinstrumentation surgery.
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F6
The surgery reduced her scoliosis to 18  (Figure 6).