title: The course of sagittal plane abnormality in the patients with congenital scoliosis managed with convex growth arrest.
abstract: BACKGROUND
  Patient age; localization, length, and magnitude of the curve; and sagittal plane alignment are reported to be the major determinants in the selection of patients for convex growth arrest. Although the existence of sagittal plane abnormality (kyphosis or lordosis) is accepted as a contraindication for convex growth arrest, this issue has not been discussed in detail.
  
  
  OBJECTIVE
  The purposes of this study are to investigate the effect of sagittal plane abnormality on the control of coronal plane deformity and to evaluate the course of sagittal plane abnormality of the patients with congenital scoliosis who were satisfactorily managed with convex growth arrest.
  
  
  METHODS
  Retrospective analysis.
  
  
  METHODS
  Inclusion criteria are: 1) a diagnosis of congenital scoliosis in a patient younger than 6 years of age, 2) treatment with convex growth arrest, 3) follow up for more than 2 years, 4) stabilized or improved coronal plane deformity, and 5) abnormal sagittal plane alignment within the scoliotic segment before surgery. The patients were evaluated with anteroposterior and lateral radiographs, and segmental measurements were compared according to the normal of their corresponding age.
  
  
  RESULTS
  A total of 38 patients with congenital scoliosis treated with convex growth arrest were reviewed. Among 13 patients with segmental sagittal plane deformity, 2 were excluded because of insufficient control of the scoliosis. Eleven patients (8 girls, 3 boys) with a mean age of 35 months (range 6-72 months) and mean follow-up of 40 months (range 24-76 months) fulfilled these criteria. The coronal plane deformities were 58 degrees (range 36 degrees-105 degrees) before surgery and 52 degrees (13 degrees-107 degrees) at the final follow-up. While six of the curves improved, the remaining ones stabilized. Sagittal segmental alignments within the scoliotic segments were hyperkyphotic in 9 patients and hypokyphotic in 1 and lordotic in 1. At the end of the follow-up, sagittal Cobb angle of the abnormal segments remained stable in 7 patients and deteriorated in 4. None of the 4 patients required any reconstructive spine procedure for kyphosis during follow-up.
  
  
  CONCLUSIONS
  Sagittal segmental abnormality does not have a negative effect on the control of scoliosis in the majority of the patients (11 of 13). If the coronal curve stabilizes or improves, then sagittal segmental abnormality could also be stabilized (in 7 of 11 patients).
authors.affiliation: Hacettepe University, Faculty of Medicine, Departments of Orthopaedics, Ankara, Turkey.
authors.forename: Akin
authors.initials: A
authors.lastname: Cil
authors.forename: Muharrem
authors.initials: M
authors.lastname: Yazici
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.forename: R Emre
authors.initials: RE
authors.lastname: Acaroglu
authors.forename: Akin
authors.initials: A
authors.lastname: Uzumcugil
authors.forename: Adil
authors.initials: A
authors.lastname: Surat
mesh_terms: D002675:Child, Preschool; D000075202:Contraindications; D018450:Disease Progression; D004838:Epiphyses / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000150:complications; D008141:Lordosis / Q000150:complications; D008297:Male; D019637:Orthopedic Procedures; D011859:Radiography; D012189:Retrospective Studies; D012272:Ribs / Q000002:abnormalities; D012600:Scoliosis / Q000150:complications / Q000151:congenital / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013131:Spine / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000473:pathology*; D016896:Treatment Outcome