A 19-year-old girl with CP at GMFCS V was referred to our department for treatment of a progressive spinal deformity. She had no history of respiratory failure until the age of 14 years. Within the past year of her first visit to our department, she was ambulanced to the ER twice due to acute oxygen desaturation. X-ray in assisted sitting position and computed tomography (CT) demonstrated severe scoliosis with a Cobb angle of 157 ° and tracheal stenosis at T2 due to compression between the innominate artery and the cervicothoracic hyperlordosis, suggesting that her acute oxygen desaturation had been caused by the impaired airway clearance at this level (Fig. a-c). After preoperative halo traction for three weeks, she underwent PSF from C7 to L5 with Ponte osteotomy at T1/2/3/4 and sublaminar taping from T1 to T6 to correct cervicothoracic hyperlordosis and thoracolumbar scoliosis simultaneously. Postoperative X-ray and CT revealed that her tracheal stenosis improved in parallel with the correction of cervicothoracic hyperlordosis. She had not developed respiratory failure until 1.5 years after surgery (Fig. d-f).
A 17-year-old girl with CP at GMFCS V was referred to our department for surgical treatment of her spinal deformity. Within the past year of her first visit to our department, she needed emergency hospitalization twice for acute respiratory failure and has been recommended for tracheostomy due to tracheal stenosis. Although her preoperative anterior-posterior radiograph in the supine position showed thoracolumbar scoliosis with a Cobb angle of 130 °, which seemed to have little impact on her thoracic cavity, preoperative lateral X-ray and CT clearly demonstrated a flattened tracheal lumen at the T3/4 level due to exaggerated cervicothoracic hyperlordosis (Fig. a-c). After preoperative halo traction for three weeks, she underwent PSF from C7 to L5 with Ponte osteotomy at T2/3/4/5/6 and sublaminar taping from T2 to T5 like case 1 (Fig. d, e). Postoperative CT revealed expansion of the tracheal lumen (Fig. f). Although she required gastrostomy postoperatively due to severe aspiration pneumoniae, she developed no respiratory failure related to impaired airway clearance during the one-year follow-up period without having a tracheostomy.