title: Congenital thoracic scoliosis with unilateral unsegmented bar, convex hemivertebrae, and fused concave ribs with severe progression after posterior fusion at age 2: 40-year follow-up after revision anterior and posterior surgery at age 8.
abstract: METHODS
  Case report with 40-year follow-up after definitive surgery.
  
  
  OBJECTIVE
  To show that extensive spine fusion in a young child can control the curve and does not necessarily lead to early death.
  
  
  BACKGROUND
  Recent efforts to avoid early spine fusion by using either progressive lengthening of spinal or rib cage implants are based on the theory that early spine fusion is deleterious and results in early death due to pulmonary compromise. Unfortunately, there is little to no documentation to support this theory.
  
  
  METHODS
  This is a single case report of a child who at the age of 3 months had a 32° congenital thoracic congenital scoliosis with a unilateral unsegmented bar, concave fused ribs, and convex hemivertebrae. By age 2 years, the curve had progressed to 64°, so a posterior fusion was done from T5 to T12. By age 8 years, the curve had dramatically increased, and she was referred to the author. She underwent a double-wedge osteotomy, both anteriorly and posteriorly, plus anterior fusion T4-L3 and posterior fusion from T1 to L3. A halo cast was used for correction.
  
  
  RESULTS
  At a 40-year follow-up after her definitive surgery at the age of 8 years, she is still alive and functioning well, although her vital capacity is poor.
  
  
  CONCLUSIONS
  Extensive thoracic spine fusion at an early age did not result in early death, but the patient is far from ideal.
authors.affiliation: Twin Cities Spine Center, Minneapolis, MN, USA. jwinhaven@aol.com
authors.forename: Robert B
authors.initials: RB
authors.lastname: Winter
mesh_terms: D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008875:Middle Aged; D012086:Reoperation; D012272:Ribs / Q000002:abnormalities / Q000601:surgery*; D012600:Scoliosis / Q000151:congenital* / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000002:abnormalities / Q000601:surgery*; D013905:Thoracoplasty; D016896:Treatment Outcome