|
Year |
2002 |
|---|---|
|
Question Number |
19 |
|
Category |
Pediatric Orthopaedics |
Question
A 14-year-old girl who is 1 year postmenarche has a progressive, apex right thoracolumbar scoliosis that measures 55 degrees by the Cobb method. She also has a nonprogressive grade I isthmic spondylolisthesis at the lumbosacral junction. She reports no pain, and her neurologic examination is normal. Management should consist of arthrodesis of
1. the spondylolisthesis and observation of the scoliosis.
2. the spondylolisthesis and bracing of the scoliosis.
3. the scoliosis and observation of the spondylolisthesis.
4. both conditions as one long fusion.
5. both conditions as two separate areas of fusion.
Figures
Answer (click for answer)
Preferred response: 3
The incidence of pars defects in patients with idiopathic scoliosis is 6.2%. This paper reviewed the treatment of patients with these two issues. They concluded that each problem should be treated independently. In a situation where treatment of the scoliosis necessitates fusion to L4 in the presence of an asymptomatic low grade, nonprogressive spondylolisthesis then fusion only to L4 should be performed. If the spondylolisthesis becomes progressive or symptomatic then the fusion can be later extended.
Indications for treatment of adolescent idiopathic scoliosis:
20-40 degrees (Risser 0-3)-Full-time TLSO bracing for curves with an apex of T8 or below. Full-time CTLSO bracing for curves with an apex above T8.
40-50 degrees (Immature)-Consider fusion
>50 degrees (Mature)-Consider fusion
Indications for surgical treatment of pediatric spondylolisthesis:
Documented slip progression beyond 25-33%, presentation with slippage greater than 50%, Persistence of mechanical or neurologic symptoms despite significant appropriate nonsurgical management, or progressive postural deformity or gait abnormality.
Reference: Fisk JR, Moe JH, Winter RB: Scoliosis, spondylolysis, and spondylolisthesis: Their relationship as reviewed in 539 patients. Spine 1978;3:234-245.
Koval, KJ (ed): OKU 7. Rosemont IL, American Academy of Orthopaedic Surgeons, 2002, pp 649.