Surgical Treatment: 5-Year-old with Increasing Spinal Deformity

Fusionless instrumentation was recommended based on the patient's age, curve flexibility, and intolerance of external bracing. Preoperative pulmonary function tests showed a forced vital capacity of 1.02 L. (57% pred.), although it was noted that the patient was unable to fully exhale due to "weakness". At age 5+9, the patient underwent implantation of fusionless instrumentation from T1-L4, producing local fusion of the cephalad hook claw anchors at T1-T2 and the distal L3-L4 pedicle screw claws (Figure 3A, 3B).

Figure 3A

Figure 3B

An additional C7 sublaminar wire was used to augment the upper claw construct against posterior pullout. Using long subfascial rods from the lumbar anchors, contoured for appropriate sagittal plane alignment, the thoraco-lumbar kyphosis was corrected by "convex" technique pushing the kyphotic apex ventrally. The caudal rods were dominoed to shorter thoracic rods, again contoured for kyphosis, in an area where subsequent distraction would not produce undesired flattening or rod prominence, because the overlapping rods had the same radius of kyphotic contour appropriate for the mid thoracic spine (Figure 3C).

Figure 3C