title: Severe idiopathic scoliosis with respiratory insufficiency treated with preoperative traction and staged anteroposterior spinal fusion with a 2-level apical vertebrectomy.
abstract: BACKGROUND
  Severe adolescent idiopathic scoliosis with respiratory insufficiency is infrequently seen in North America currently.
  
  
  OBJECTIVE
  To present the case of a teenager from Moscow, Russia who was referred to our center with a severe scoliosis and respiratory compromise.
  
  
  METHODS
  A case report on the evaluation and surgical treatment of a severely deformed teenager.
  
  
  METHODS
  A 14+10-year-old was referred to our center for treatment of a 149 degrees thoracic scoliosis. Preoperative pulmonary function tests (PFTs) revealed severe restrictive disease with a forced vital capacity (FVC) of 1.3L (34% predicted) and a forced expiratory volume in 1 second (FEV(1)) of 0.99L (31% predicted). She underwent a 2-stage anterior and posterior 2-level vertebral column resection (VCR) with preoperative and in between anterior and posterior stage perioperative halo-gravity traction.
  
  
  RESULTS
  Her thoracic scoliosis was corrected to 48 degrees over 3 years postoperative. Her 3-year follow-up PFT revealed an FVC of 1.85L (52% predicted) and an FEV(1) of 1.6L (50% predicted).
  
  
  CONCLUSIONS
  A staged anterior and posterior VCR with intervening halo-gravity traction is a viable option to treat severe scoliosis in patients with restrictive pulmonary function.
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Nepple
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D005260:Female; D006801:Humans; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012600:Scoliosis / Q000150:complications* / Q000628:therapy*; D013123:Spinal Fusion / Q000379:methods*; D014143:Traction / Q000379:methods