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Abstract: A 2-year-old boy, whose parents accidentally noticed an uneven lower back and bulging left lumbar region when bathing him, aroused their alarm and brought the child to the hospital, where the examination revealed that the child had congenital scoliosis. As a result of early detection of congenital scoliosis and treatment with hemivertebral resection spinal orthopedic fixation and fusion surgery, the child’s scoliosis was effectively controlled and he recovered very well after surgery.
Basic information】Male, 2 years old
Disease Type】Congenital scoliosis
Hospital】Beijing Children’s Hospital of Capital Medical University
Date of Consultation】February 2022
Treatment Plan】Surgical treatment (hemivertebral resection spinal orthopedic fusion surgery)
Treatment Period】7 days after inpatient surgery
Effectiveness】The hemivertebrae were completely removed and the spinal deformity was corrected and controlled.
I. Initial consultation
One day, the child’s father was standing behind the child to give him a bath while the child was bending down to pick up a toy that had fallen on the floor. At first, the father thought the child was not standing properly, but after repeated self-examination, he found that the child’s back was indeed uneven, so he brought the child to the hospital as soon as possible, and found that the child’s waist was asymmetrical bilaterally when the body was bent forward, with the left side bulging higher than the right side (Figure 1), considering the possible existence of scoliosis and The results showed congenital scoliosis and lumbar 3½ vertebral malformation (Figure 2).
(Figure 1)
(Figure 2)
II. Treatment history
Through the previous examination and detailed inquiry, we basically grasped the child’s condition. Since the child’s hemivertebral deformity is of the fully segmented type, which has a greater impact on spinal balance, and has now caused a relatively large local curvature, and the future deformity is progressing at a faster rate, combined with the child’s current age, it was recommended that surgery be performed as soon as possible to remove the deformed hemivertebral body and to fix the vertebrae above and below the hemivertebral body for orthopedic treatment. To correct the local deformity that has already appeared. The parents were given a detailed and patient explanation of the specific circumstances of the child’s disease and treatment recommendations, taking into account that the child’s current diagnosis of congenital scoliosis combined with hemivertebral deformity is clear, and the hemivertebral body has already caused significant deformity locally, and with the growth of the hemivertebral body will also cause serious effects on the local lumbar spine and even the entire spine and trunk. The most effective treatment is early surgery to remove the hemivertebrae, correct the local deformity, and control its further progression. Although the parents were concerned about the risks of surgery, they decided to cooperate fully with the surgeon and perform surgery as soon as possible after fully understanding the child’s condition and the consequences of the disease progression.
Next, arrangements were made for the child to be hospitalized and for routine preoperative examinations to be performed. In order to better understand the deformity and precise surgical planning, the child also underwent a preoperative CT examination (Figure 3), and through adequate preoperative preparation and planning, the surgical procedure went very smoothly, and the child’s left hemivertebra of lumbar 3 was seen during surgery. “At the same time, the local deformity was completely corrected by placing pedicle screws in the upper and lower vertebrae and connecting them with metal rods and orthopedics, and the deformity was controlled in time before it was further aggravated.
(Figure 3)
III. Treatment results
After surgery, the child’s condition was relatively stable, except for the wound pain, basically no other discomfort performance, the child resumed eating on the second day after surgery; on the third day after surgery, the child’s wound was changed, the wound recovery is good, also relatively beautiful. On the 6th day after surgery, the staff of the orthopedic office provided the child with an anterior and posterior spinal brace to limit the movement of the spine, protect the stability of the spine and the internal fixation system, and promote early fusion, and also explained to the child’s parents the precautions to take after returning home. The child was discharged from the hospital the next day.
(Figure 4)
IV. Precautions
I was very pleased with the parents’ smiles and the improvement of the child’s condition, and I was happy for them. However, parents should be advised that in order to ensure the fusion of the deformed segment and the safety of the internal fixation, they should cooperate with the doctor to limit the child’s activities and avoid strenuous activities and accidental injuries, except for bed rest. In addition, the child should be encouraged to eat more food rich in calcium, protein and vitamins to promote the healing of the trauma and bone repair, and should be reviewed and followed up regularly according to the doctor’s requirements.
V. Personal insight
Early diagnosis and early treatment of congenital scoliosis are advocated, and treatment methods include plaster, braces, surgery, etc. In cases where the deformed segment is relatively short and the potential for progression of the deformity is large, early surgery should be performed to completely correct the deformity and avoid the appearance of secondary deformities.
Congenital scoliosis generally worsens with age and can have a negative impact on the growth of the trunk and spine of the child, and can even lead to serious consequences such as inequality of the lower limbs, motor sensory impairment of the lower limbs, and fecal incontinence when the nerves are compressed. Fortunately, the scoliosis of this child with congenital scoliosis was corrected in time after standard treatment, and postoperative care should include early braking, attention to spinal protection, and enhanced nutrition to help promote spinal repair.