Correção de curva de alto grau na escoliose idiopática do adolescente

cirurgia estadiada

Abstract

Female, 14-years-old patient complaining of toracic deformity, without pain and functional limitation. Start of the deformity at age 8. At physical examination severe deformity was noted in torso. In the radiographic examination showed proximal thoracic curve with 44º (T1-T5), main thoracic with 124º (T5-T11) and lumbar with 57° (T12-L4). X-rays images with lateral inclinations showed correction 32º, 126º e 144º, respectively. There was a kyphosis in sagittal plane (T4-T12) of 62°. According to the Lenke classification we considered a type 4B+ and according to King-Moe classification the deformity is type II. The treatment plan was posterior instrumentation and arthrodesis of T3-L4, with osteotomy type VCR (“Vertebral Column Ressection”) of T8. Two-phase surgery was performed and in the first-phase was accomplished the instrumentation of T3-L1, bypassing T8 (VCR) and, with the placement of a temporary stem for segment stability. There was correction for T1-T5: 40° (44°), T5-T11: 73° (124°), T11-L4: 52° (62°). Thus, we decided for a change in surgery planning with the performance of multiple osteotomies in posterior column, due to the good result of the first correction. The final result showed correction for 45° between T5-T11, representing a decrease on initial curve of 69% and 18º between T11-L4, 29% of initial. We conclude that two-phase surgery and placement of a temporary stem we can gain a better understanding of the curve and being able to perform a specific treatment for each case.