(based on classification of
King et al) assistance provided by Ben Allen Jr. M.D.
- See:
Selection of Fusion Level:
- Discussion: - cosists of a major thoracic curve (does not cross mid-line) and a flexible secondary lumbar curve; -
treatment: - distraction is the primary form of treatment; - fusions should not end at the thoraco-lumbar junction but rather extend to at least to L2; - no down going hooks are placed in thoracic spine; - two hooks cannot be placed at the same level, but are rather staggered to avoid the risk of posterior arch frx; -
concave side of curve: - major corrective force is achieved w/ distraction from end hooks; - superior up-going hook is placed one level above end vertebrae; - middle up-going hook is placed at apex of curve; - fusion usually needs to extend past L2; - down going hook is placed two levels below end vertebrae -
convex side of curve: - these are staggered relative to concave hooks; - distal down going hook is placed one level above ditsal concave hook; - if the shoulder is high on the concave side, then the convex up-going hook is placed one level caudad relative to the concanve hook; - w/ severe asymmetry, the hook is placed two levels caudad; - note: distraction on the concave side may elevate the ipsilateral shoulder; - in this case, the shoulder will be low on the concave side, and therefore, the convex up-going hook is placed on level cephalad relative to the concanve hook; - w/ severe asymmetry, the hook is placed two levels cephalad; -
treatment pitfalls: shoulder height asymmetry;
