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Rapidly Progressive Scheuermann's Disease in an Adolescent following Pectus Bar Placement Treated with Posterior Vertebral Column Resection: Case Report and Review of the Literature.
MedLine Citation:
PMID:  23202355     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
ABSTRACT: STUDY DESIGN: Case report and review of the literature.OBJECTIVE: This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. This patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction.SUMMARY OF BACKGROUND DATA: Scheuermann's kyphosis is a disease process defined by strict radiographic and clinical criteria. Surgical treatment is generally recommended for curves greater than 75° in magnitude. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction.METHODS: Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral column resection and T4-L3 instrumented posterior spinal fusion.RESULTS: The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction.CONCLUSIONS: The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.
Authors:
Patrick A Sugrue; Brian A O'Shaughnessy; Kathy M Blanke; Lawrence G Lenke
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-11-29
Journal Detail:
Title:  Spine     Volume:  -     ISSN:  1528-1159     ISO Abbreviation:  Spine     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-12-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7610646     Medline TA:  Spine (Phila Pa 1976)     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
1Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA 2Neurological Surgery, Howell Allen Clinic, Nashville, TN, USA 3Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA.
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