PMC5296840_01
(a) Chest X-ray taken 6 months prior to presentation to us showing mild scoliosis and few absent ribs on the right side (b) X-ray at presentation to us showed right-sided scoliosis with Cobb's angle 41 . Destruction of ribs has increased as compared to Figure 1a. (c) Three-dimensional reconstruction of the chest (Sternum has been digitally subtracted for better visualization of chest wall.) showing absent ribs on (R) side (4th to 7th rib) (d) Sagittal view showing severe narrowing of the canal at the apex of kyphosis. (e) Dicom image showing the level at which image in Figure 1f has been taken. (f) Axial cut showing osteolysis (arrow) in body and pedicle of vertebrae proximal to the apex
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F1
An X-ray taken elsewhere 6 months prior to presentation to OPD showed mild scoliosis with few ribs absent on the right side [Figure 1a]. The 4th to 7th ribs on the right side were absent with destruction in the lower ribs more as compared to the X-ray taken 6 months back [Figure 1b]. Three-dimensional reconstruction showed a complete absence of the right 4th-7th ribs [Figure 1c]. In addition, right-sided pedicles and right half of vertebral bodies proximal to the apex showed osteolysis [Figure 1e and f]. There was severe narrowing of the canal at the apex of kyphosis [Figure 1d].
(a and b) Postoperative X-ray dorsal spine anteroposterior and lateral views showing full correction of scoliosis with implant in situ (c) Peroperative photograph showing posterior fixation and reconstruction using fibulae
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F2
Additional matchstick graft prepared from remaining fibulae was placed posteriorly [Figure 2c]. Postoperative X-ray showed full correction of deformity [Figure 2a and b].
(a and b) Radiographs of dorsal spine anteroposterior and lateral views at 1 year followup showing maintenance of alignment; however, anterior fusion is not seen. (c) Computed tomography scan at one year showing anterior void and fibulae had not united
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F3
X-ray at 1-year postoperatively showed that alignment is maintained [Figure 3a and b]; however, consolidation of the anterior graft was not seen. A CT scan showed an anterior void and the fibulae had not united with the host bone [Figure 3c].
(a and b) Anteroposterior and lateral radiographs of dorsal spine at 7 months followup showing maintenance of alignment. (c) Computed tomography scan at 7 months following anterior reconstruction showing that tricortical graft has not resorbed but no fusion at graft host bone interface
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F4
Radiographs revealed maintained alignment [Figure 4a and b]. CT showed that anterior strut graft has not resorbed; however, it still has not united with the host bone [Figure 4c].