Staged corrective surgery for complex adolescent kyphoscoliosis caused by back scalding during the childhood period

Abstract

Introduction: Adolescent scar contracture kyphoscoliosis is a very rare disease.

Methods and results: Here, we present the case of a 21-year-old man who was scalded due to ebullient water when he was 10 years old. Moreover, kyphoscoliosis was found when he was 12 years old and developed rapidly. Thereafter, no management was proposed before his consultation at our center. On examination, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view, extensive contractured scar presented on the right side of the back, abdomen, chest wall, hip, right thighs and armpit anterior, especially in the right flank. A one-stage correction was deemed too risky, we therefore released contractured scar during the first stage with the defect of soft tissue protected by vacuum sealing drainage and then performed skeletal traction with halo and bilateral femoral pins. A reasonable correction was achieved without any neurological deficits 1 month after traction. Next, a second-stage operation was taken to translate a free anterolateral thigh myocutaneous flap to overlay the extensive defect of soft tissue. 1.5 months later, a third posterior segmental pedicle screw instrumented fusion with Smith-Peterson osteotomy between T9 and L2 was performed. Postoperative recovery was uneventful and as there were no complications, he was discharged 10 days after the third surgery. At 2-year follow-up the patient's outcome is excellent with balance and correction of the deformity.

Conclusion: Based this grand round case and relevant literature, we discuss the different options for the treatment of adolescent scar contracture scoliosis.

Fig. 1

Before the operation, extensive contractured scar presented on the right side of the back, abdomen, chest wall, hip, right thighs and armpit anterior, especially in the right flank of the patients

Fig. 2

a Initial AP and lateral standing X-rays of the patient. The left thoracolumbar curve was 122° with an apex at T11, and kyphosis was 100°, and b 1.5 months after Halo-bilateral femoral traction, the AP X-rays showed that coronal major curve was 72°

Fig. 3

a Standing AP and Lateral X-rays 2 years after surgery, the coronal curve was 60°, b kyphosis was 25°, and c two years after operation