title: Rapidly progressive Scheuermann's disease in an adolescent after pectus bar placement treated with posterior vertebral-column resection: case report and review of the literature.
abstract: METHODS
  Case report and review of the literature.
  
  
  OBJECTIVE
  This case illustrates the importance of the costosternal complex in maintaining the stability and alignment of the thoracic spine. The patient was iatrogenically destabilized by placement of a pectus bar leading to rapid symptomatic progression of his Scheuermann's kyphosis, ultimately requiring surgical correction.
  
  
  BACKGROUND
  Scheuermann's kyphosis is a disease process defined by strict radiographical and clinical criteria. Surgical treatment is generally recommended for curves greater than 75°. This case demonstrates the critical role of the costosternal complex in maintaining the stability of the thoracic spine. The patient described in this report underwent placement of a pectus bar for correction of symptomatic pectus excavatum. He subsequently developed a progressive symptomatic Scheuermann's kyphosis as a result of the destabilization of his costosternal complex. This patient ultimately required removal of the pectus bar and posterior instrumented kyphosis correction.
  
  
  METHODS
  Progressive symptomatic Scheuermann's kyphosis (105°) corrected by removal of the pectus bar, T11 posterior vertebral-column resection and T4-L3 instrumented posterior spinal fusion.
  
  
  RESULTS
  The patient had an uneventful immediate postoperative course. He was discharged neurologically intact with dramatic kyphosis correction and significant symptomatic improvement. Radiographs obtained 3 years postoperatively reveal stable thoracolumbar correction.
  
  
  CONCLUSIONS
  The costosternal complex plays a critically important role in the intrinsic stability of the thoracic spine. Iatrogenic disruption of the costosternal complex can result in rapid progression of thoracic/thoracolumbar kyphosis in the setting of Scheuermann's disease.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA. p-sugrue@fsm.northwestern.edu
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Sugrue
authors.forename: Brian A
authors.initials: BA
authors.lastname: OʼShaughnessy
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Blanke
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D001696:Biomechanical Phenomena; D020878:Device Removal; D018450:Disease Progression; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D007049:Iatrogenic Disease; D008279:Magnetic Resonance Imaging; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects* / Q000295:instrumentation; D011859:Radiography; D016059:Range of Motion, Articular; D012086:Reoperation; D012544:Scheuermann Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome