32 Posterior Scoliosis Correction

A double thoracic curve pattern is one in which there are two structural thoracic curves. Most commonly, it is a high left thoracic, low right thoracic curve. Usually the lower right thoracic curve is the bigger of the two curves, but the upper curve determines the shoulder balance (Fig. 32–1).

Indications for Surgery

1. The indications are the same as for other forms of idiopathic adolescent scoliosis. If the curves are substantial enough, then surgery is considered.

2. Because both curves are relatively structural, it is best to fix both of the curves.

3. Fixing both the curves is indicated in the following situation:

a. Left shoulder higher than right.

b. Upper thoracic curve exceeding 40 degrees.

c. The upper thoracic curve not bending out beyond 25 degrees.

d. Substantial high, left thoracic hump on forward bending.

Contraindications

The only absolute contraindication is a skin problem that prevents posterior fusion and instrumentation.

Advantages

The advantage of the posterior approach is that both curves are corrected, and this creates a more balanced spine if, in fact, there is a double thoracic pattern.

Disadvantages

The only disadvantage is that more of the upper thoracic segments are fused. At present, there are no compelling data to suggest that this increases the likelihood of breakdown in either the cervical spine or the lumbar spine. Most commonly, fusion levels for a double thoracic scoliosis are T2 to L1 or L2.

Procedure

Fusion levels: The most common levels are T2 to L1 or L2. This depends on the segments that are within the curve.

Incision Options

Related posts:

Posterior Cervical Laminectomy and Fusion Odontoid Fixation Anterior Thoracoscopic Release for Spinal Deformity Anterior Cervical Corpectomy Anterior Lumbar Interbody Fusion Total Lumbar Disc Replacement Using the SB III Charite Prosthesis

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