title: Transpedicular eggshell osteotomies for congenital scoliosis using frameless stereotactic guidance.
abstract: METHODS
  Three cases of multiplanar congenital scoliosis corrected by a transpedicular eggshell osteotomy using frameless stereotactic guidance are reported.
  
  
  OBJECTIVE
  To show an alternative surgical technique for correcting and fusing complex congenital spinal curves.
  
  
  BACKGROUND
  Children with congenital scoliosis can have progressive curves causing significant multiplanar deformities. In older children, traditional approaches to spinal corrective surgery including fusion in situ, convex growth arrest, and hemivertebra excision can achieve only limited corrections.
  
  
  METHODS
  Three older patients who had congenital scoliosis with significant multiplanar curves underwent one-stage posterior transpedicular eggshell osteotomy. Three-dimensional reconstructive images and frameless stereotactic guidance were used for preoperative selection of osteotomy levels and accurate placement of pedicle screws. After completion of the osteotomy, closure was obtained with extension of the hips.
  
  
  RESULTS
  The average coronal correction of the major curve was 28.7 degrees (range, 22-33 degrees ). The average correction of the plumb line or lateral displacement from the center of the trunk was 4.8 cm (range, 3-7.5 cm). A significant kyphotic deformity was corrected 38 degrees, and a pelvic tilt was reduced from 7 to 3 cm.
  
  
  CONCLUSIONS
  One-stage posterior reduction eggshell osteotomy can be used to correct a sagittal and/or coronal congenital spinal curve imbalance. Frameless stereotactic guidance for solid pedicle screw fixation was essential to the achievement of rigid spinal stabilization before arthrodesis. Transpedicular eggshell osteotomy is a technique that should be considered for older patients who have congenital scoliosis with multiplanar spinal abnormalities.
authors.affiliation: Section of Orthopaedic Surgery, University of Michigan Hospitals, Ann Arbor, Michigan, USA.
authors.forename: M R
authors.initials: MR
authors.lastname: Mikles
authors.forename: G P
authors.initials: GP
authors.lastname: Graziano
authors.lastname: Hensinger aR
mesh_terms: D000293:Adolescent; D002648:Child; D006801:Humans; D021621:Imaging, Three-Dimensional; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010027:Osteotomy / Q000379:methods*; D011859:Radiography; D012600:Scoliosis / Q000151:congenital / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013238:Stereotaxic Techniques