Absent pedicles in campomelic dysplasia.
OBJECTIVES
The objective of the present study is to report a case of campomelic dysplasia illustrating the absence of cervical and thoracic pedicles. This report reiterates the importance of this clinical peculiarity in the setting of spine instrumentation.


MATERIALS AND METHODS
A 10-year-old female patient with campomelic dysplasia presented with progressive kyphoscoliosis and signs of neural compromise. Imaging studies confirmed thoracic level stenosis and demonstrated absence of multiple pedicles in cervical and thoracic spine. The patient underwent decompression and instrumentation/fusion for her spinal deformity.


RESULTS
The patient was instrumented between C2 and L4 with pedicle screws and sublaminar cables. However, pedicle fixation was not possible for the lower cervical and upper-mid thoracic spine. Also, floating posterior elements precluded the use of laminar fixation in the lower cervical spine. Cervicothoracic lumbosacral orthosis (CTLSO) was used for external immobilization to supplement the tenuous fixation in the cervicothoracic area. The patient improved neurologically with no signs of implant failure at the 2-year follow-up.


CONCLUSIONS
Absence of pedicles and floating posterior elements present a challenge during spine surgery in campomelic dysplasia. Surgeons should prepare for alternative fixation methods and external immobilization when planning on spinal instrumentation in affected patients.


LEVEL OF EVIDENCE
Level IV Case Report.
['McDowell|Michael M|MM|', 'Dede|Ozgur|O|', 'Bosch|Patrick|P|', 'Tyler-Kabara|Elizabeth C|EC|']
D055036:Campomelic Dysplasia D002574:Cervical Vertebrae D002648:Child D005260:Female D005500:Follow-Up Studies D006801:Humans D013123:Spinal Fusion D013904:Thoracic Vertebrae
Campomelic Kyphoscoliosis Camptomelic Dysplastic Pediatric Skeletal dyplasia