Circumferential Resection and Shortening Procedure for Congenital Kyphosis and Scoliosis in a Skeletally Immature Male

Narrative
This is a 13-year-old boy who presents for evaluation of congenital scoliosis and kyphosis. He presents with an 85-degree thoracolumbar scoliosis, which corrects to 70-degrees in the supine x-ray. There is not substantial flexibility to this curve on the right and left side-bending films nor is there much flexibility on the push-prone film. He also has a component of kyphosis to this deformity as well. If you look closely, you will see he has principally failures of formation rather than failures of segmentation. Classically, with failures of segmentation one will see a lordotic deformity. With failures of formation, one will see a kyphotic deformity.

Figure 1
Standing AP and lateral and supine long cassette x-rays
on the patient demonstrating his scoliosis and kyphosis.

Figure 2
Left and right side bending x-rays and push-prone
radiograph demonstrating the lack of flexibility with this deformity.

Figure 3
The patient's clinical appearance in the coronal, sagittal and axial planes.

The boy was otherwise healthy. He did have an MRI done to screen for spinal cord anomalies. His conus ends at L2. Otherwise, the MRI was unremarkable.

Surgical Treatment
The patient was treated first with an anterior operation where several discs were removed throughout the deformity and bone grafted with morselized bone. Then at the apical segment, a vertebral body was resected. Posteriorly then, a V-shaped resection was made posteriorly through the same segment, including posterior element and pedicle on the right side. This v-shaped segment was then closed down posteriorly with cantilever and compression forces.

This resection procedure had the effect of shortening the right side of the spine and also shortening the posterior column. Therein, correction of the scoliosis and kyphosis was accomplished. Fusion and instrumentation was then performed the length of the deformity. After closing down the structures posteriorly, the anterior wound was then reopened. A small gap was left anteriorly. This small anterior gap was then supported with cage and morselized bone graft as you can see.

Figure 4
Standing AP and lateral x-rays on the patient at 3 months postop.

Figure 5
The patient's clinical appearance at 3 months postop.

Figure 6
Comparative radiographs of the patient standing preop and 3 months postop.

Figure 7
Clinical appearance of the patient preop and postop.

Bibliography
Bradford DS, Tribus CB: Vertebral Column resection for the treatment of rigid coronal decompensation. Spine 1997:22(14):1590-1599