title: Progression of idiopathic thoracolumbar scoliosis after breast reconstruction with a latissimus dorsi flap: a case report.
abstract: METHODS
  A report of a patient in whom progressive symptomatic thoracolumbar scoliosis developed after breast reconstruction with a latissimus dorsi myocutaneous flap.
  
  
  OBJECTIVE
  To present the first reported case of progressive symptomatic scoliosis after breast reconstruction with a latissimus dorsi myocutaneous flap and to suggest that latissimus flap harvest may be contraindicated in patients with preexisting scoliosis.
  
  
  BACKGROUND
  Latissimus dorsi myocutaneous flap harvest incorporated into several surgical operations including breast reconstruction has been presented as a relatively benign procedure without significant biomechanical consequence. Nevertheless, various anatomic and animal studies have suggested an important role for balanced latissimus function in terms of proper spinal alignment. Long-term follow-up evaluation of patients after latissimus flap harvest is insufficient and fails to address the specific issue of spinal deformity.
  
  
  METHODS
  Postoperative radiographs demonstrated significant progression of the patient's thoracolumbar scoliosis as compared with radiographs taken before her latissimus harvest. Curve progression accompanied by development of severe and disabling back pain were considered indications for surgical curve correction and stabilization.
  
  
  RESULTS
  At the time of 1-year follow-up assessment after posterolateral spinal fusion and instrumentation, the patient had experienced complete relief from her back pain and satisfactory spinal fusion.
  
  
  CONCLUSIONS
  Although a cause and effect relation cannot be established, this case study suggests that latissimus harvest may have a destabilizing effect on the thoracolumbar spine in the long term, especially in patients with preexisting scoliosis. Alternative procedures should be considered in these patients.
authors.affiliation: Harvard Combined Orthopaedics Residency Program, and the Boston Orthopaedics Group, Boston, Massachusetts 02446, USA.
authors.forename: D H
authors.initials: DH
authors.lastname: Kim
authors.forename: P A
authors.initials: PA
authors.lastname: Glazer
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000601:surgery*; D000075202:Contraindications; D018450:Disease Progression; D005260:Female; D006801:Humans; D016462:Mammaplasty / Q000009:adverse effects*; D018482:Muscle, Skeletal / Q000601:surgery; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000209:etiology*; D013524:Surgical Flaps / Q000009:adverse effects