Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy

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.

Keywords: Adolescent idiopathic scoliosis, Restrictive lung disease, Anterior and posterior vertebrectomy, Vertebral column resection, Halo-gravity traction