LAUSR

In the article by Angelliaume et al., the authors describe a very interesting surgical procedure by treating a hyperextension of the whole spine in a thirteen-year-old patient suffering from congenital muscular dystrophy [1]. The patient had a grotesque sitting position in the wheelchair, resulting in severe back pain. The patient presented a thoracic scoliosis of 72 , lumbar lordosis of 68 , thoracic kyphosis of only 9 , and a fixed cervical hyperextension of 52 . The spinal hyperextension was compensated with a major hip flexion. Firstly, the authors corrected the spine by thoracoscopic anterior release and a posterior correction including a fusion using a modified Luque–Galveston instrumentation from T1 to the pelvis. This resulted in a non-satisfying correction in the sagittal plane. Thus the correction of the lumbar lordosis was achieved, but not the correction of the thoracic hypokyphosis. Additionally, the patient developed a surgical site infection followed by two revision surgeries and prolonged antibiotics. Despite the partial correction of the sagittal plane, the sitting position with hyperextension of the cervical spine was not satisfying. The authors decided to correct the cervical hyperextension progressively, using an adjustable cranial halo ring fixed to a thoracic corset. They corrected the deformity very slowly using threaded rod constructs on both sides in-between the halo and the corset over a period of 3 month. After complete correction that resulted in the patient’s ability of a horizontal view, they added a cervical spinal posterior fusion without instrumentation and continuing halo corset for 4 months. After a total treatment of 8 months, the spine was balanced and the patient’s sitting position was satisfying.