(Disclaimer: This article is only for popular science purposes, in order to protect patient privacy, the following content in the relevant information has been processed)
Abstract: This 5-year-old girl, the parents found that her body was not straight when standing and sitting, and both shoulders were not equal in height, initially thought that it was caused by bad posture habits, usually always reminded the child to pay attention to, and also bought the child a posture corrector, but then the parents found that the child’s posture still could not be improved, so they took the child to the hospital, and after examination, it was found that the child had congenital scoliosis, and after surgical treatment, congenital After surgery, the congenital scoliosis was completely corrected.
Basic information】Female, 5 years old
Type of disease】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 in hospital
Results】Scoliosis was corrected and controlled, and balance was restored to both shoulders.
I. Initial consultation
The first time I saw the child was in the outpatient clinic. The child’s parents brought the child to the clinic, and the child was very obedient and knowledgeable. However, the parents found that the child’s posture still could not be improved, so they brought the child to see a doctor.
I checked the appearance of the child’s back and performed orthopedic examinations, and the child was very cooperative. I found that the child’s left shoulder was significantly higher than the right shoulder in natural standing (Figure 1), and the back was asymmetrical bilaterally when the body was bent forward. Figure 2).
(Figure 1)
(Figure 2)
II. Treatment history
The child’s condition was basically grasped through previous examinations and detailed inquiries. Since the child’s hemivertebral deformity was located in the thoracic segment of the spine and was of the fully segmented type, it had a greater impact on spinal balance and had now caused a relatively large local curvature, as well as leading to thoracic deformity and shoulder and trunk imbalance, and the deformity was progressing at a faster rate in the future, and combined with the child’s current age, surgery was recommended as soon as possible. The deformed hemivertebra was removed and the vertebrae above and below the hemivertebra were fixed orthopedically to correct the current deformity and improve the balance of the shoulder and trunk.
After detailed consultation about the treatment plan, the risks associated with the surgery and the long-term development of the disease, the parents decided to cooperate fully with the doctor and perform the surgery.
First of all, the child’s hospitalization and preoperative routine examination were arranged to exclude contraindications to surgery. In order to better understand the deformity and precise surgical planning, the child also underwent a preoperative CT examination (Figure 3). Through adequate preoperative preparation and planning, the surgical procedure went very smoothly, and the deformity of the left hemivertebrae of the child’s thoracic 10 was seen intraoperatively. Through a series of operations such as screw placement, hemivertebral resection, metal rod attachment, and compression orthopedics, the deformed hemivertebrae and adjacent cartilage growth plate were completely removed, completely The local deformity was corrected, and the deformity was controlled in time before it was further aggravated.
(Figure 3)
III. Treatment results
The child’s condition was stable after the surgery, except for hypothermia and wound pain in the first 3 days after surgery, there was basically no other discomfort, and he resumed eating on the second day after surgery. On the day of the dressing change, the child underwent an X-ray examination, which showed stable internal fixation, complete hemivertebral resection, satisfactory orthopedic spinal deformity, and regained balance of the shoulder and trunk (Figure 4).
(Figure 4)
IV. Notes
I am very pleased that the child’s condition has improved, but I would like to advise the child and parents that they should cooperate with the doctor to limit the child’s activities until the spine has fully recovered after discharge. In the daily diet, pay attention to foods rich in calcium, protein and vitamins, pay attention to regular review and follow-up, and encourage the child to actively perform functional exercises of the trunk and limbs after the review to confirm complete fusion.
V. Personal insight
This child’s disease was discovered by chance when the parents observed the child’s posture. If the parents did not care or did not seek further medical attention, the best time to diagnose and treat the disease might have been missed, so careful observation of the child is usually important for both parents and clinicians.
If congenital scoliosis is not treated in a timely manner, it can adversely affect the child’s growth and development, and can lead to severe consequences such as unequal lower limbs, lower limb motor sensory impairment, and fecal incontinence, so parents should be reminded to pay attention to it.