Staged corrective surgery for complex congenital scoliosis and split cord malformation
| العنوان: | Staged corrective surgery for complex congenital scoliosis and split cord malformation |
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| المؤلفون: | Muhammad Asad Qureshi, Ambreen Asad, Ibrahim Farooq Pasha, Arslan Sharif Malik, Vincent Arlet |
| المصدر: | European Spine Journal. 18:1249-1254 |
| بيانات النشر: | Springer Science and Business Media LLC, 2009. |
| سنة النشر: | 2009 |
| مصطلحات موضوعية: | medicine.medical_specialty, medicine.medical_treatment, Scoliosis, Neurosurgical Procedures, Boston brace, Clinical Protocols, Traction, Preoperative Care, Deformity, Humans, Medicine, Orthopedics and Sports Medicine, Treatment Failure, Thoracotomy, Child, Spinal Cord Injuries, Monitoring, Physiologic, business.industry, Grand Rounds, Traction (orthopedics), medicine.disease, Surgery, Radiography, Spinal Fusion, medicine.anatomical_structure, Spinal fusion, Thoracic vertebrae, Female, Neurosurgery, medicine.symptom, Tomography, X-Ray Computed, business, Diskectomy |
| الوصف: | Congenital scoliosis associated with split cord malformation raises the issue on how to best manage these patients to avoid neurologic injury while achieving satisfactory correction. We present the case of a 12-year-old girl who first presented when she was 11-year old with such combination but without much physical handicap or neurological deficit. The corrective surgery offered at that time was refused by the family. She again presented after 1 year with documented severe aggravation of the curve resulting in unstable walking and psychological upset. Her imaging studies showed multiple malformations in lower cervical and thoracic spine and a split cord malformation type 2 (fibrous septum with diplomyelia) at the apex of the deformity. A one-stage correction was deemed neurologically too risky. We therefore performed during a first stage a thoracotomy with anterior release. This was followed by skeletal traction with skull tongs and bilateral femoral pins. After gradual increase in traction weights a reasonable correction was achieved without any neurological deficit, over the next 10 days. A second-stage operation was done on the 11th day and a posterior instrumented fusion was performed. Post-operative recovery was uneventful and there were no complications. She was discharged with a Boston Brace to be worn for 3 months. At 2-year follow-up the patient outcome is excellent with excellent balance and correction of the deformity. In this grand round case, we discuss all the different option of treatment of congenital scoliosis associated with split cord malformation. In a medical environment where spinal cord monitoring is lacking, we recommend an initial release followed by skull and bifemoral traction over several days to monitor the neurologic status of the patient. Once optimal correction is achieved with the traction, a posterior instrumentation can be safely done. |
| تدمد: | 1432-0932 0940-6719 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::a8afbd574b29612b37d0bab3b00c0d4c https://doi.org/10.1007/s00586-009-1099-1 |
| حقوق: | OPEN |
| رقم الأكسشن: | edsair.doi.dedup.....a8afbd574b29612b37d0bab3b00c0d4c |
| قاعدة البيانات: | OpenAIRE |
Find this article in full text from Springer Verlag. | تدمد: | 14320932 09406719 |
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