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King Type II Scoliosis

(based on classification of King et al) assistance provided by Ben Allen Jr. M.D.

- See: Selection of Fusion Level
- Discussion: 
- "S" shaped thoracolumbar curve crosses midline; 
- thoracic curve is larger and stiffer than lumbar curve; 
- selective arthrodesis of the thoracic curve in King type II curves may lead to larger residual lumbar and loss of balance; 
- over correction of main thoracic curve may be one of problems, because in lumbar curve, spontaneous correction is not sufficient to restore balance; 
- treatment: 
- the goal w/ this type of curve is to preserve lumbar lordosis along w/ a motion segment; 
- usually w/ flexible curves less than 45 deg, lumbar fusion can be limited to L3 or higher; 
- distally the up-going convex lumbar hook and the down going concave hook are placed at the same level; 
- convex lumbar curve: 
- down going proximal hook and up going distal hook; 
- concave lumbar curve: 
- down going distal hook, at same level as convex distal hook; 
- concave thoracic curve: 
- down going distal hook (which is also the down going hook of the upper lumbar curve; 
- up going hook at apex of the curve; 
- up going hook above end vertebrae; 
- convex thoracic curve: 
- up going hook at apex of curve which is staggered from the apex concave up going hook 
- up going hook above proximal end vertebrae, which is staggered from opposite 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

The selection of fusion levels in thoracic idiopathic scoliosis.