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    Scolioza Congenitala

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    Iulia Dulgheru
    Ashley was diagnosed with congenital scoliosis caused by a hemivertebra at her L1 vertebra and a wedge vertebra at her L5 vertebra. She underwent posterior spinal fusion from L4 to S1 using titanium implants to prevent further progression of her curve. An osteotomy was also performed to remove bone from her deformed L5 vertebra. Post-operatively, she recovered in a wheelchair and brace. The surgery and hardware successfully halted the progression of her scoliosis and she has no physical limitations as a champion swimmer.

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    Scolioza Congenitala

    Uploaded by

    Iulia Dulgheru
    133 views20 pages
    Ashley was diagnosed with congenital scoliosis caused by a hemivertebra at her L1 vertebra and a wedge vertebra at her L5 vertebra. She underwent posterior spinal fusion from L4 to S1 using titanium implants to prevent further progression of her curve. An osteotomy was also performed to remove bone from her deformed L5 vertebra. Post-operatively, she recovered in a wheelchair and brace. The surgery and hardware successfully halted the progression of her scoliosis and she has no physical limitations as a champion swimmer.

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    studiu de caz

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    Ashley was diagnosed with congenital scoliosis caused by a hemivertebra at her L1 vertebra and a wedge vertebra at her L5 vertebra. She underwent posterior spinal fusion from L4 to S1 using titanium implants to prevent further progression of her curve. An osteotomy was also performed to remove bone from her deformed L5 vertebra. Post-operatively, she recovered in a wheelchair and brace. The surgery and hardware successfully halted the progression of her scoliosis and she has no physical limitations as a champion swimmer.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    133 views20 pages

    Scolioza Congenitala

    Uploaded by

    Iulia Dulgheru
    Ashley was diagnosed with congenital scoliosis caused by a hemivertebra at her L1 vertebra and a wedge vertebra at her L5 vertebra. She underwent posterior spinal fusion from L4 to S1 using titanium implants to prevent further progression of her curve. An osteotomy was also performed to remove bone from her deformed L5 vertebra. Post-operatively, she recovered in a wheelchair and brace. The surgery and hardware successfully halted the progression of her scoliosis and she has no physical limitations as a champion swimmer.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 20

    Case Study: Ashley

    Congenital Scoliosis w/ Hemivertebra & Wedge Vertebra


    6 years to 7 years

    David S. Feldman, MD
    Chief of Pediatric Orthopedic Surgery
    Professor of Orthopedic Surgery & Pediatrics
    NYU Langone Medical Center & NYU Hospital for Joint Diseases

    BACKGROUND

    At the age of 6, Ashleys mother noticed a


    curve in her spine and her pediatrician
    referred them to orthopedic doctors for
    further evaluation.

    MRIs and x-rays showed a 30 degree curve


    in her spine (scoliosis) along with a vertebra
    that was undeveloped on one side
    (hemivertebra). There was no family history
    of either scoliosis or kyphosis.

    DIAGNOSIS

    During my examination of Ashley, I


    confirmed the previous findings and
    diagnosed:
    Hemivertebra at Lumbar 1 vertebra (L1)
    Decompensation (curving) of the trunk towards
    one side due to hemivertebra
    Congenital wedge vertebra (deformed vertebra)
    at Lumbar 5 vertebra (L5)

    Fig 1. Anterior x-ray of Ashleys spine.


    Fig 2. A cross section MRI of Ashleys L1 vertebra.
    Fig 3. A posterior CT Scan of Ashleys lumbar vertebrae.

    TREATMENT

    While non-surgical bracing is an option in


    some cases of scoliosis, it is ineffective in
    cases such as this where a hemivertebra is
    causing a progressive deformity. As a result,
    surgery was performed to straighten
    Ashleys spine, realign her trunk, and
    prevent further progression of her scoliosis.

    Posterior Spinal Fusion


    An incision was made from
    the base of Ashleys L4 to S1
    vertebra. A titanium XIA 4.5
    implant was affixed with
    screws to the L4 and S1
    pedicles to fuse the two levels
    together preventing further
    progression of Ashleys curve.

    Screws were not affixed to the L5 because


    the L4 to S1 fusion provided sufficient
    fixation. The L1 hemivertebra was stabilized
    by the lower spinal fusion and was to be
    observed rather than surgically altered.

    Osteotomy
    A wedge of bone was removed from the
    right side of her L5 vertebra to correct the
    deformity.

    To aid healing and prevent infection, closure


    of the wound was completed by Dr. Michael
    Margiotta of Plastic Surgery.

    Post Op Treatment

    To prevent infection, a course of antibiotics


    began during the operation and continued for
    two weeks after surgery.

    Due to the wedge resection of her vertebra,


    Ashley used a wheelchair for 6 weeks and a
    brace for 6 months to protect her body while
    she healed.
    After surgery Ashley came into the office
    every six months and then once per year for
    follow-ups.

    Ashley in her reclining wheelchair after surgery.

    CONCLUSION

    The temporary brace


    and permanent internal
    hardware stabilized
    Ashleys hemivertebra,
    halting the progression
    of her scoliosis, and
    keeping her curve in the
    range of 20 to 25
    degrees even as she
    grew.

    Ashley is now a champion freestyle


    swimmer with no physical limitations.

    David S. Feldman, MD
    Pediatric Orthopedic Surgeon
    www.davidsfeldmanmd.com

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