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In Situ Fusion
The surgical choice for a progressive kyphotic deformity is a solid fusion or arthrodesis of the deformed vertebrae. The fusion may also include one normal vertebra above and one normal vertebra below this area. Bone graft from the patient or tissue bank is placed posteriorly, on the back of the spine, along the area of the abnormality. In severely angulated curves, additional bone graft may be placed anteriorly, on the front of the spine, as well as from behind. The fusion may be performed with or without the use of instrumentation.
In situ fusion is a non-instrumented fusion without correction of the angulation. The bone graft will require 4-6 months to mature into a solid fusion mass. During the postoperative period the fusion must be protected with a cast or brace until X-rays demonstrate a solid fusion.
A&B) Front and side X-rays of a child with lumbar congenital kyphosis.
C) A CT 3-D reconstruction showing the malformaion.
D&E) Front and side views of a structural bone graft between L3-S1.