(based on classification of King et al) assistance provided by Ben Allen Jr. M.D.
- See: Selection of Fusion Level:
- Discussion:
- consists of a major thoracic curve (does not cross mid-line) and a flexible secondary lumbar curve;
- treatment:
- distraction is the primary form of treatment;
- fusions should not end at the thoraco-lumbar junction but rather extend to at least to L2;
- no down going hooks are placed in thoracic spine;
- two hooks cannot be placed at the same level, but are rather staggered to avoid the risk of posterior arch frx;
- concave side of curve:
- major corrective force is achieved w/ distraction from end hooks;
- superior up-going hook is placed one level above end vertebrae;
- middle up-going hook is placed at apex of curve;
- fusion usually needs to extend past L2;
- down going hook is placed two levels below end vertebrae
- convex side of curve: - these are staggered relative to concave hooks;
- distal down going hook is placed one level above ditsal concave hook;
- if the shoulder is high on the concave side, then the convex up-going hook is placed one level caudad relative to the concanve hook;
- w/ severe asymmetry, the hook is placed two levels caudad;
- note: distraction on the concave side may elevate the ipsilateral shoulder;
- in this case, the shoulder will be low on the concave side, and therefore, the convex up-going hook is placed on level cephalad relative to the concanve hook;
- w/ severe asymmetry, the hook is placed two levels cephalad;
- treatment pitfalls: shoulder height asymmetry
- See: Selection of Fusion Level:
- Discussion:
- consists of a major thoracic curve (does not cross mid-line) and a flexible secondary lumbar curve;
- treatment:
- distraction is the primary form of treatment;
- fusions should not end at the thoraco-lumbar junction but rather extend to at least to L2;
- no down going hooks are placed in thoracic spine;
- two hooks cannot be placed at the same level, but are rather staggered to avoid the risk of posterior arch frx;
- concave side of curve:
- major corrective force is achieved w/ distraction from end hooks;
- superior up-going hook is placed one level above end vertebrae;
- middle up-going hook is placed at apex of curve;
- fusion usually needs to extend past L2;
- down going hook is placed two levels below end vertebrae
- convex side of curve: - these are staggered relative to concave hooks;
- distal down going hook is placed one level above ditsal concave hook;
- if the shoulder is high on the concave side, then the convex up-going hook is placed one level caudad relative to the concanve hook;
- w/ severe asymmetry, the hook is placed two levels caudad;
- note: distraction on the concave side may elevate the ipsilateral shoulder;
- in this case, the shoulder will be low on the concave side, and therefore, the convex up-going hook is placed on level cephalad relative to the concanve hook;
- w/ severe asymmetry, the hook is placed two levels cephalad;
- treatment pitfalls: shoulder height asymmetry
The selection of fusion levels in thoracic idiopathic scoliosis