Congenital Scoliosis Requiring Only One-level Fusion

Description

The patient first came to Dr. Bridwell as a baby—just 6 months old. She’d been born with a hemivertebra in her lumbar spine (waistline level between the rib cage and pelvis), which happens when one side of a vertebra doesn’t develop all the way. It causes the spine to grow crooked. Her parents had noticed a hump on her back, and they were referred to Dr. Bridwell. He said she had congenital scoliosis, and her curve was about 30º.

As time passed, the baby showed developmental delays and was diagnosed with an Arnold-Chiari malformation of the brain stem, a 10p chromosome deletion, neuronal migration disorder, and epilepsy.

Treatment

Dr. Bridwell monitored the patient’s curves, and he explained to her parents that if it reached or exceeded a certain level, surgery would be necessary to prevent further deformity and complications, especially considering her other medical conditions.

When the patient was 3½ years old, her curve was at 40º, and Dr. Bridwell strongly recommended surgery. He performed a posterior spinal fusion on her lumbar spine because that’s where the hemivertebra was. He used pedicle screws in the spine, and then he attached rods to the pedicle screws. The screws and rods held and stabilized the spine while the bones healed and fused.

A very short fusion, just one level above and one level below, and 100% correction of the curve was accomplished by resecting the hemivertebra. The 40° curve was corrected to 0° and only one level of the spine was fused.

For six months after surgery, the patient wore a body brace that went from her shoulders to her thighs. This helped support and stabilize the spine while the bones healed. It also prevented her—a very active 3-year-old—from moving too much and injuring herself.

Result

At 5 years post-op, she is running, playing, and jumping—just like a normal 9-year-old.