A few weeks back I had a Blog entry regarding Zachary, a wonderful 9 yo boy, who was the victim of “Shaken Baby Syndrome” as an infant, with severe brain injury and subsequent severe motor and other deficits.
He had a couple of thoracic fractures at that time, and has developed a huge kyphoscoliosis to the point where he cannot sit in his wheelchair, and is experiencing significant pain, and cannot be braced.
Today, we did posterior reconstructive surgery using pediatric pedicle screw instrumentation from T1-L3.
Zachary did just great.  Estimated total blood loss was 400 cc.  He received one pint of blood, and 123 cc of cell saver and had a postoperative hemoglobin of 12.
His curve was very stiff, not correcting significantly when he was prone.
Extra care was needed to position him, given his severe kyphosis.
I performed 4 posterior thoracic osteotomies to try to free up the spinal mobility to aid in the correction of the deformity.
The spinal correction was performed in a step-wise fashion, starting at the top and then working my way down the spine, attaching the rods to the screws on each side, while gently pressing down on the rods like a lever.
Intra-operative radiograph as well as postoperative physical examination shows excellent correction of his kyphoscoliosis.
Zachary was extubated immediately after surgery, and is doing well tonight in the WakeMed Pediatric Intensive Care Unit (PICU)

Many thanks to the wonderful team who helped out today in OR 9 at WakeMed Raleigh, which included:  Katherine who assisted me as FNA, Yan Yan and Sheila as scrub techs, Vondella and Angela who helped out as nurse circulators, Martin and Melissa who were our CRNA and SRNA, and Dr. Jeremy who was our anesthesiologist.

Lloyd A.  Hey, MD MS
https://www.heyclinic.com
Hey Clinic for Scoliosis and Spine Surgery
Raleigh, NC USA