title: Surgical treatment of spondylitis and diaphragm relaxation in patient less than 1 year old.
abstract: METHODS
  Case report.
  
  
  BACKGROUND
  The combination of severe post-infectious kyphosis and diaphragm relaxation is extremely rare in patient early than 1 year old. Its no publications concerning their simultaneous surgical treatment.
  
  
  METHODS
  7-Month-old girl had simultaneous spinal reconstruction with anterior and posterior instrumentation and plastic of diaphragm because of sequelae of non-granulenatous spondylitis complicated by severe kyphosis (54°) and diaphragm relaxation. Between 1.5 and 3 months of live she had several infections incl. pneumonia, enterocolitis, ENT infection. Anterior fusion was done by titanium mesh with auto-rib, posterior - by compressive rods based on low-profile hooks. The deformity was reduced till 20°. 2.5 years after initial surgery and 1 year after removal of posterior instrumentation the adequate level of diaphragm and minimal (4°) loss of kyphosis correction were identified.
  
  
  CONCLUSIONS
  The combination of spondylitis and diaphragm relaxation in early aged patient could be explained but it could not be confirmed as a sequelae of late-onset neonatal sepsis with a multi-focal lesions. The simultaneous surgery provided on the combined approaches (trans-thoracic and posterior) looks as optimal options in such combination of pathologies. In remains controversial how will the spine develop after so early reconstructive surgery, including in situ stable anterior fusion carried out by titanium mesh with auto-rib.
authors: St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation; St-Petersburg North-West State Medical University named by I.I. Mechnikov, St-Petesburg, Russian Federation. Electronic address: aymushkin@mail.ru.
authors: A Y
authors: AY
authors: Mushkin
authors: St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation. Electronic address: eymalyarova@gmail.ru.
authors: E Y
authors: EY
authors: Malyarova
authors: St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation. Electronic address: v.a.evseev@mail.ru.
authors: V A
authors: VA
authors: Evseev
authors: St-Petersburg Science-Research Institute of Phthisiopulmonology, St-Petesburg, Russian Federation; St-Petersburg State University, St-Petesburg, Russian Federation. Electronic address: glhirurgb2@mail.ru.
authors: P K
authors: PK
authors: Yablonskii
mesh_terms: D003964:Diaphragm / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007239:Infections / Q000150:complications; D007738:Kyphosis / Q000150:complications / Q000601:surgery; D008159:Lumbar Vertebrae / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D019651:Plastic Surgery Procedures / Q000379:methods*; D018805:Sepsis / Q000150:complications; D013131:Spine / Q000601:surgery; D013166:Spondylitis / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Diaphragm relaxation; Neonatal sepsis; Pediatric spine surgery; Spondylitis; Titanium mesh