Thoracic Scoliosis



- Discussion:
    - progression:
          - rt thoracic curves > 50 deg are at highest risk for progression (1 deg/yr) followed by Rt lumbar curves;
          - single thoracic curves> 70-75 deg at growth completion progress an average of about 17 deg;
    - high thoracic or cervicothoracic curves usually are of congenital etiology and rarely are idiopathic & often produce major deformity;
    - left thoracic scoliosis is rare, and evaluation of spinal cord by MRI, is performed to rule out cord abnormalities;

- PreOp Planning:
     - isolated arthrodesis of thoracic curve in King type II curves may result in worsening of lumbar curves postoperatively and loss of 
           balance;
     - overcorrection of main thoracic curve may also lead to asymmetric neck and shoulder contour;
     - double thoracic curve (King type V)
           - do not assume that the upper (left) thoracic curve is non-structural without proof, and if there is any question, fuse the upper 
                   thoracic spine as well as the lower thoracic spine;

- Choices of Instrumentation:
    - Harrington Instrumentation:
           - gold standard for treatment of thoracic idiopathic scoliosis;
    - CD instrumentation:
           - may be method of choice for correcting sagittal contour, esp when thoracic spine is hypokyphotic;
           - may be used for double curves and lumbar curves because it can restore and preserve the sagittal contour while increasing 
                  rigidity;
    - Luque instrumentation: (w/ sublaminar wiring)
           - largely has been abandoned for treatment of idiopathic scoliosis due to morbidity and rate of complications



Scoliosis in children after thoracotomy for aortic coarctation.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Tuesday, April 24, 2012 4:42 pm