16-year old Lingamurty [name changed] had a progressive spinal deformity since early childhood. He had undergone foramen magnum decompression for Chiari malformation, in early childhood. This is a surgery done at the junction of head and neck so as to restore circulation of fluid in the brain and spine. Despite this, his deformity had progressively increased.
On presentation to Dr. Yogesh K. Pithwa, he had evidence of right lumbar and left thoracic curve. Radiographs revealed an additional wedge vertebra at the thoracolumbar junction leading to focal kyphosis. However, his overall sagittal balance was well maintained [head centered over pelvis]. Hence, the author performed a posterior surgical correction over a long segment utilizing the relative flexibility of thoracic segments above and the lumbar segments below to adequately correct the sagittal profile of the patient. The long segment fixation necessary for scoliosis correction was advantageously utilized to correct sagittal profile in this patient. Though hemivertebra excision has its own role and advantages in surgical correction, it is well-known that this procedure entails risks higher [upto 44%] t
han the option exercised in this patient [17%]1. His postoperative lumbar lordosis was 570, while thoracic kyphosis was 370 [demonstrating an ideal difference of 200 between the two]. His pelvic incidence was 520, again showing a healthy relationship with lumbar lordosis.
1: Efficacy of hemivertebra resection for congenital scoliosis: a multicenter retrospective comparison of three surgical techniques. Yaszay B et al. Spine (Phila Pa 1976). 2011 Nov 15;36(24):2052-60