title: Revision surgery for curve progression after implant removal following posterior fusion only at a young age in the treatment of congenital scoliosis: A case report.
abstract: BACKGROUND
  Congenital scoliosis due to a hemivertebra creates a wedge-shaped deformity, which progresses and causes severe spinal deformities as an individual grows. The treatment of congenital scoliosis focuses on early diagnosis and appropriate surgical management before the development of severe deformity.
  
  
  METHODS
  We report the case of a 4-year-old male child with a left thoracolumbar scoliosis of 27° (T10-T12) due to a T11 hemivertebra who was treated by posterior fusion and pedicle screw fixation at the age of 4 years. The implant was removed due to pain secondary to implant prominence after 4 years without definitive revision surgery, which led to significant progression of the scoliosis, to 50°. The indication for posterior vertebral column resection (PVCR) is a congenital spinal deformity with a curve magnitude greater than 30° with fast progression. This includes documented progression of the curve by more than 5° in a 6- month period, failure of conservative treatment, or both.
  
  
  RESULTS
  The patient underwent PVCR of the T11 hemivertebra. Nine years after the revision surgery with PVCR, the patient showed satisfactory results and his spine was well balanced.
  
  
  CONCLUSIONS
  This case shows that removal of an implant that was not the only cause of curve progression at a young age may lead to progression of scoliosis and, therefore, should be avoided unless it is absolutely necessary.
  
  
  CONCLUSIONS
  Congenital scoliosis due to a hemivertebra at a young age could be treated by hemivertebra resection or anterior and posterior epiphysiodesis as definitive surgical treatment. The patient was eventually treated with PVCR, which achieved satisfactory correction without curve progression in a long-term follow-up.
authors.affiliation: Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University Department of Orthopaedic Surgery, Korea University Guro-Hospital, College of Medicine, Korea University Department of Orthopaedic Surgery, Kyung Hee Hospital, College of Medicine, Kyung Hee University Department of Orthopaedic Surgery, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea Department of Orthopaedic Surgery, The University Hospital for Albert Einstein College of Medicine, Albert Einstein College of Medicine, New York, NY Department of Orthopaedic Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Dong-Gune
authors.initials: DG
authors.lastname: Chang
authors.forename: Jae Hyuk
authors.initials: JH
authors.lastname: Yang
authors.forename: Jung-Hee
authors.initials: JH
authors.lastname: Lee
authors.forename: Jung-Sub
authors.initials: JS
authors.lastname: Lee
authors.forename: Seung-Woo
authors.initials: SW
authors.lastname: Suh
authors.forename: Jin-Hyok
authors.initials: JH
authors.lastname: Kim
authors.forename: Seung-Yeol
authors.initials: SY
authors.lastname: Oh
authors.forename: Woojin
authors.initials: W
authors.lastname: Cho
authors.forename: Jong-Beom
authors.initials: JB
authors.lastname: Park
authors.forename: Se-Il
authors.initials: SI
authors.lastname: Suk
mesh_terms: D001863:Bone Screws; D002675:Child, Preschool; D020878:Device Removal / Q000009:adverse effects*; D018450:Disease Progression; D006801:Humans; D008297:Male; D012086:Reoperation; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation*