Extreme Lordoscoliosis of Spine Corrected With Simultaneous Spinal Surgery And Hip Joint Extension Osteotomies

A 19-year old female presented with syndromic spinal deformity. Though scoliosis was present, the most functional limitation was related to her extreme lordosis.

She had lumbar lordosis of 860 [normal range being 400-600]. Her thoracic spine had a LORDOSIS of 400 [normal being KYPHOSIS of 100-400]. As thoracic lordosis is correlated with pulmonary compromise and hence, life expectancy; it was essential to get maximal correction of the sagittal profile. Detailed evaluation revealed an element of hip joint flexion deformity as well. Hence, a team surgery involving the author [spine surgeon] and a paediatric Orthopaedic surgeon was carried out. This involved bilateral hip joint extension osteotomies and correction of spinal deformities with particular attention to correcting the sagittal profile. This led to correction of her thoracic profile to KYPHOSIS of 100 [125% correction] and lumbar lordosis reduced to 520 [40% correction]. Since lumbar lordosis was compensating the hip flexion deformity to some extent, bringing it into the physiological range was found adequate for her. Her scoliosis too, improved from 680 to 340 [50% correction]. This case highlights evaluation of the patient as a whole to optimize treatment outcomes. Utilizing femoral osteotomies to achieve good standing balance highlights a team approach in the management of these complex cases!

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