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Surgical correction of a previously operated juvenile idiopathic scoliosis with crankshaft phenomenon: an illustrative case report

ABSTRACT:

Background

Crankshaft phenomenon secondary to posterior fusion for scoliotic deformity at a young age has become rare and its management can be very challenging.

Case Description

We report the case of an 11-year-old girl who has been complaining of a progressively increasing hump in her back with waist and shoulders asymmetry during the past 6 months. Three years prior to presentation, she underwent in another institution posterior correction fusion from T3 to L3 for a juvenile idiopathic scoliosis with a Cobb angle of 60°. After the initial correction, follow-up X-rays revealed a progressive increase of the scoliosis angulation with the onset of a coronal malalignment mainly at the cervicothoracic junction. Full spine anteroposterior and lateral X-rays revealed a long right thoracolumbar scoliosis of 70° with a rib-vertebra angle difference of 27° and the proximal right screw pulled out from the rod. CT scan confirmed the posterior fusion between the apical vertebras. MRI did not show any congenital anomaly. The patient underwent a revision surgery with instrumentation from T1 to L4, and posterior column osteotomies at 6 levels between T4 and T10. Coronal Cobb angle corrected to 11° with satisfactory sagittal alignment and a maintained correction at 3 years of follow-up.

Conclusions

This is the first case to thoroughly illustrate surgical management in the onset of a crankshaft phenomenon. Through a posterior-only approach, the use of posterior column osteotomies at the apex of the deformity in order to release the previous fusion is a safe and satisfactory option to reestablish proper coronal and sagittal alignment, with satisfactory clinical and radiological long-term results.

SUBMITTER: Bourghli A

PROVIDER: S-EPMC9547701 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Project description:Background In order to improve post-operative patient’s quality-of-life, attention must be paid to the identification of factors that play a role in patient’s satisfaction with surgical treatment. Patient satisfaction with the outcomes of scoliosis surgery has not been addressed so comprehensively in Saudi literature, as well as the effect of patient satisfaction on the different domains of the SRS-22 questionnaire and radiographic parameters is yet to be reported locally. The aim of this study is to explore such findings especially in our population. Methods A retrospective cohort study was conducted at two of the largest centers of spine surgery in the Kingdom of Saudi Arabia. A total of 316 eligible patients were selected via consecutive sampling technique. Data were collected from eligible patients who fit our inclusion criteria, which includes patients with adolescent idiopathic scoliosis aged from 10 to 21 years. Student t test, Pearson’s and Spearman’s correlation coefficients statistical tests were used. Results There were 283 (89.6%) females and 33 (10.4%) male patients with a mean age of 15.09 (± 2.27 SD) years. All the domains of SRS-22 showed significantly higher scores 2-year postoperatively, when compared with preoperative values (P < 0.001). The change in all SRS-22 domains correlated positively and significantly with the 2-year postoperative satisfaction using Pearson’s correlation coefficient (P < 0.05); the total score showed the highest correlation followed by the self-image domain. The major Cobb angle correction percentage correlated significantly (P < 0.05) solely with the change in pain domain. Conclusion Self-image correlated highly and significantly with patient satisfaction postoperatively. It also had the biggest influence SRS-22 scores postoperatively in conjunction with satisfaction scores. That is an indication of the role it plays in patient satisfaction and quality-of-life postoperatively, which may influence the surgical decision making. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-023-03925-z.

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