Single-Stage Posterior-Only In Situ Fixation and Fusion for Neglected Congenital Vertebral Aplasia With...

Neglected congenital kyphoscoliosis with vertebral aplasia, absent pedicles, and rib anomalies presents a formidable challenge, especially in low-resource settings. We report the case of a 28-year-old man with progressive thoracolumbar deformity, cosmetic concerns, and fatigue. Imaging revealed congenital vertebral aplasia with pedicle agenesis from D10 to D12, a missing left 12th rib, and a dysplastic right L1 pedicle. The patient underwent a single-staged posterior-only surgical correction using basic fluoroscopic guidance. Surgical management included multilevel pedicle screw fixation, wide posterior facetectomies, decompression, foraminotomies, in situ rod contouring, and posterolateral fusion with allograft. No vertebral column resections were performed. Postoperative imaging demonstrated stable correction and alignment. At three months, the patient had significant cosmetic improvement, fatigue resolution, and no neurological deficits. This case demonstrates the utility of posterior-only deformity correction and fusion in complex neglected congenital kyphoscoliosis, using accessible surgical techniques without reliance on advanced intraoperative technology in a resource-limited setting.