Adolescent scar contracture scoliosis caused by back scalding during the infantile period

Abstract

The study design was a retrospective study in adolescent scar contracture scoliosis caused by back scalding during the infantile period. The objective of the study was to investigate the pathogenesis, clinical manifestation and treatment of adolescent scar contracture scoliosis caused by back scalding during the infantile period. This condition seldom occurs and is not reported in current English literature. One patient was first treated with skin expansion, back scar excision and skin flap transfer, followed by anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release. One patient was treated with posterior correction with TSRH instrumentation, and thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at an interval of 3 weeks. The deformities of four patients were well corrected. Trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up. Severe scar contracture caused by back scalding during the infantile period could lead to adolescent scoliosis. Its pathogenesis and clinical manifestation are different from the typical adolescent idiopathic scoliosis. The treatment of this kind of scoliosis should be individualized.

Fig. 1

A 15-year-old boy with scar contracture thoracolumbar scoliosis with a Cobb angle of 54° (a, b, c). Skin expansion, back scar excision and flap transfer were performed before spine surgery (d, e, f). Four months later, he had anterior TSRH instrumentation for his thoracolumbar scoliosis with a correction rate of 72% (g)

Fig. 2

A 15-year-old girl with severe scar and scar contracture scoliosis (a). The pre-operative Cobb angle was 103° (b, c) and the spinal deformity was corrected dramatically, the trunk well balanced and the pelvis leveled. The post-operative X-ray films showed that the residual Cobb angle was 46° with a correction rate of 55% (d). The X-ray films at 3 months and 3 years follow-up showed no implant migration and no obvious loss of correction was found. (e, f)

Fig. 3

A 23-year-old girl with scars located on the chest, the whole back, abdomen, two thighs, two gluteus and part of the upper extremities (a). The Cobb angle of curvature was 85° (b, c). The spinal deformity was corrected and the post-operative Cobb angle was 39° with a correction rate of 54% (d). The X-ray films at 1 year 9 months follow-up showed that the implant position was very good and no obvious loss of correction was seen (e)

Fig. 4

The clinical photo of an 11-year-old girl with scar located on the left armpit and left hypochondrium (a). The curve ranged from T5 to L5 with a Cobb angle of 80° (b, c). The spinal deformity was corrected after the operation. The trunk was balanced. The post-operative Cobb angle was 35° with a correction rate of 56% (d, e)