Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy
Received 6 June 2008; accepted 17 January 2009. published online 24 February 2009.
Abstract
Background context
Severe adolescent idiopathic scoliosis with respiratory insufficiency is infrequently seen in North America currently.
Purpose
To present the case of a teenager from Moscow, Russia who was referred to our center with a severe scoliosis and respiratory compromise.
Study design/setting
A case report on the evaluation and surgical treatment of a severely deformed teenager.
Methods
A 14+10-year-old was referred to our center for treatment of a 149° thoracic scoliosis. Preoperative pulmonary function tests (PFTs) revealed severe restrictive disease with a forced vital capacity (FVC) of 1.3L (34% predicted) and a forced expiratory volume in 1 second (FEV1) of 0.99L (31% predicted). She underwent a 2-stage anterior and posterior 2-level vertebral column resection (VCR) with preoperative and in between anterior and posterior stage perioperative halo-gravity traction.
Results
Her thoracic scoliosis was corrected to 48° over 3 years postoperative. Her 3-year follow-up PFT revealed an FVC of 1.85L (52% predicted) and an FEV1 of 1.6L (50% predicted).
Conclusions
A staged anterior and posterior VCR with intervening halo-gravity traction is a viable option to treat severe scoliosis in patients with restrictive pulmonary function.
ABSTRACT