Congenital scoliosis with posterior spinal arthrodesis T2-L3 at age 3 years with 41-year follow-up. A case report

STUDY DESIGN: A case report. OBJECTIVES: To document the long-term effects of early fusion for progressive congenital scoliosis. SUMMARY OF BACKGROUND DATA: There is concern about fusion at an early age causing torso shortening and possible crankshaft phenomenon. METHODS: A review of medical and radiologic records. RESULTS: A 3-year old girl with progressive congenital scoliosis had posterior spinal arthrodesis in 1955. A pseudarthrosis was repaired at age 4, and at age 8 she had an osteotomy of the fusion mass because of bending of the fusion mass. In a follow-up 41 years after fusion, she has no back pain and no history of pulmonary problems. Despite the long fusion at a young age, her torso-to-leg ratio was remarkably good. The thoracic lordosis had improved to a normal thoracic kyphosis. CONCLUSION: Early arthrodesis was life saving and caused no long-term problems. Because significant spinal growth has occurred by age 3, no adverse effects on torso-leg ratio with an early long arthrodesis, and in addition the crankshaft phenomenon is rare in congenital scoliosis.