Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.

Abstract

STUDY DESIGN:

Case report and review of the literature.

OBJECTIVE:

This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction.

SUMMARY OF BACKGROUND DATA:

Scheuermann's kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction.

METHODS:

Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion.

RESULTS:

The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction.

CONCLUSION:

The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.

• Authors: Patrick A Sugrue, Brian A OʼShaughnessy, Kathy M Blanke, Lawrence G Lenke
• Journal: Spine (Spine (Phila Pa 1976)) Vol. 38 Issue 4 Pg. E259-62 (Feb 15 2013) ISSN: 1528-1159 [Electronic] United States
• PMID: 23202355 (Publication Type: Case Reports, Journal Article, Review)

Topics

• Adolescent
• Biomechanical Phenomena
• Device Removal
• Disease Progression
• Funnel Chest (surgery)
• Humans
• Iatrogenic Disease
• Magnetic Resonance Imaging
• Male
• Orthopedic Procedures (adverse effects, instrumentation)
• Radiography
• Range of Motion, Articular
• Reoperation
• Scheuermann Disease (diagnostic imaging, etiology, physiopathology, surgery)
• Spinal Fusion (instrumentation)
• Thoracic Vertebrae (diagnostic imaging, physiopathology, surgery)
• Time Factors
• Treatment Outcome