At age three years and six months, an anterior strut graft had been surgically placed. The kyphosis continued to develop due to the anterior epiphysiodesis and a proximal pseudarthrosis. The surgical treatment included pre-operative preparation with cutaneous expanders. We then performed a resection osteotomy by a posterior approach consisting of four overlapping rods. This is a case of a 24 year old male, with a thoracic spina bifida, having had multiple surgeries presently with a progressive kyphoscoliosis.
Pulmonary examination shows that surgery is permitted.
Correction of the kyphoscoliosis will be performed by an osteotomy above the apex, and by resection of two or three vertebrae at the level of the apex. The vertebral resection also provides good graft material and could avoid plastic surgery. Looking at the risks of progression and recurrence, aggravated by the kyphosis, an anterior and posterior arthrodesis is necessary, along with posterior instrumentation. The posterior approach alone is used. The arthrodesis must be extended as far as possible anteriorly.