- 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.