PMC4983149_01
Myelograms of the patient. (a) - Kink and stenosis of the dural sac in the frontal view at the T9-T10 level. (b) - Absence of reserve subdural space in the sagittal plane at the T9-T10 level.
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The kink of the dural sac on the apex of the deformity is clearly visible (Fig. 1).
The first transthoracic stage of antero-lateral spinal cord transposition. (a) Spinal cord is released from being decompressed by walls of the spinal canal, displaced forward and toward the concave side at the T7-T11 level. The new bed of the spinal cord was formed to correct spinal deformity preventing the risk of potential spinal cord decompression in future; the flap of the anterior longitudinal ligament is turned up. (b) Completion of the first stage of spinal cord transposition (the flap of the anterior longitudinal ligament is returned to its original site).
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T7-T11 levels through the right-sided transthoracic approach; skeletal cranio-tibial traction; posterior wedge-shaped vertebrotomy at the T7-T11 levels; correction of the spine deformity using a CD Horizon instrumentation and posterior fusion with local bone autograft along the entire length of the instrumentation (T1-L4) (Fig. 2). The surgery was carried out under multicomponent total intravenous anesthesia and mechanical ventilation.
The outcome of surgical treatment observed on spondylograms (frontal view). (a) - The Cobb angle of scoliosis in the standing patient before surgery is 148 . (b) - The Cobb angle of scoliosis in the standing patient after correction is 64 ; the frontal body balance has been recovered. (c) - The Cobb angle of scoliosis in the standing patient 5 years after surgery is 64 . Artificial anterior and posterior bone blocks have been formed.
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Thick artificial and spontaneous anterior and posterior bone blocks were formed along the entire length of the spinal system; no spinal canal stenosis was revealed (Fig. 3, Fig. 4.
Patient's appearance. (a) Back view before surgical management. (b) Lateral view before surgical management. (c) Back view after surgical management. (d) Lateral view after surgical management.
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Patient's appearance improved significantly and the trunk balance was recovered (Fig. 5).