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Progressive rotational dislocation in kyphoscoliotic deformities: presentation and treatment.
1Department of Orthopaedic Pediatric Surgery, Hôpital Saint-Vincent-de-Paul, Paris, France. rzeller@imagine.fr
Spine
|May 2, 2000
Summary
Progressive rotational dislocation in kyphoscoliosis poses significant risks. Early diagnosis and surgical stabilization, including anterior strut grafting and posterior fusion, are crucial for successful outcomes and preventing neurological deficits.
Area of Science:
- Orthopedics
- Spine Surgery
- Pediatric Orthopedics
Background:
- Progressive rotational dislocation is a serious risk in kyphoscoliosis.
- Early diagnosis and treatment are essential for managing this spinal deformity.
Observation:
- A retrospective review of 11 patients with progressive rotational dislocation of kyphoscoliosis was conducted.
- Etiologies included neurofibromatosis (4 patients) and dysplastic conditions (7 patients), with structural bone weakness as a common feature.
- Three patients presented with neurologic impairment (1 complete, 2 incomplete), and four had prior failed spinal fusion attempts.
Findings:
- All but one patient achieved successful spinal fusion after circumferential stabilization (anterior strut-grafting and posterior fusion).
- Correction loss was minimal (<3 degrees) in most patients at an average 5-year follow-up.
- Neurologic deficits showed improvement in two patients with incomplete deficits; the patient with a complete deficit remained unchanged.
Implications:
- Increased awareness of progressive rotational dislocation in dystrophic kyphoscoliosis aids early diagnosis and stabilization.
- Surgical outcomes suggest that early anterior strut grafting from the concavity combined with posterior fusion is a recommended treatment strategy.
- This approach may reduce the incidence and severity of neurological deficits compared to previous reports.