Four years ago, L.R., who is now 15, had a posterior spinal fusion (PSF) for correction of idiopathic adolescent scoliosis in a pediatric orthopedic hospital in another state. Her spinal curvature had been surgically corrected with the insertion of bilateral laminar and pedicle hooks and two 3⁄16-inch rods. A bone autograft was taken from her right posterior superior ilium and applied along the lateral processes of T4 to L2 to complete the fusion.

During a follow-up visit, she presented with a significant prominence of the right scapula and back pain in the mid and lower back. She denied numbness or tingling of the lower extremities, bowel or bladder problems, chest pain, and shortness of breath. A CT scan of the upper thoracic spine showed a prominent rotatory scoliosis deformity of the right posterior thorax with acute angulation of the ribs. Her deformity is a common consequence of overcorrection of prior spinal fusion surgery, called crank shaft phenomenon.

L.R. was referred to the chief spinal surgeon of a local pediatric orthopedic hospital for removal of the spinal instrumentation, posterior spinal osteotomies from T4 to L2, insertion of replacement hooks and rods, bilateral rib resections, autograft bone from the resected ribs, partial scapulectomy, and possible allograft bone and bilateral chest tube placement. The surgical plan was explained to her and her mother and consent was obtained and signed. The surgical procedure as well as the potential benefits versus risks were discussed. L.R. and her mother stated that they fully understood and provided consent to proceed with the plan for surgery.

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