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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.