STUDY DESIGN: A retrospective study. OBJECTIVES: To determine the indications of fusing the proximal thoracic curve when treating an idiopathic thoracic scoliosis with segmental instrumentation. SUMMARY OF BACKGROUND DATA: Failure to recognize a significant proximal thoracic curve often results in postoperative shoulder asymmetry due to relative overcorrection of the lower thoracic curve. With segmental instrumentation that enhances the correction of the instrumented curve, the double thoracic curve pattern that needs fusion of both the proximal and the distal thoracic curves needs to be redefined. MATERIALS AND METHODS: Forty thoracic AIS patients with a right lower thoracic curve > 40 and a left proximal thoracic curve > 25 treated by segmental pedicle screw instrumentation were analyzed after a minimum follow up of 2 years. RESULTS: Of the 40 patients, 18 were treated by fusion of both the proximal and the distal curves while 22 were treated by fusion of the distal curve only. The postoperative shoulder height difference(SHD, mm) was 0.9 x preoperative SHD(mm) + 5.3 for the both curve fusion and 0.6 x preoperative SHD(mm) + 12 for the distal curve fusion(linear regression), showing that proximal thoracic curve fusion improved the SHD when the left shoulder was level with or higher than the right. CONCLUSIONS: An idiopathic thoracic scoliosis with a proximal thoracic curve > 25 and level or elevated left shoulder should be considered a double thoracic curve pattern and treated by both the proximal and the distal curve fusion when using a segmental instrumentation.
Adolescent* ; Follow-Up Studies ; Humans ; Retrospective Studies ; Scoliosis* ; Shoulder

Hypereosinophilic syndrome (HES) is characterized by a sustained eosinophilia of 1,500/mm3 or more in the absence of any known causes or the signs and symptoms of organ involvement. We report a 64-year-old man with HES initially presenting with involvement of the liver and bone marrow. Despite controlling the eosinophilia by corticosteroid, he developed a cerebral infarction and later progressive interstitial pneumonia. Brain angiography revealed a severe stenosis of the proximal right internal carotid artery (ICA) and a complete obstruction of the intracranial ICA. An open lung biopsy revealed fibrosis and lymphoplasma cell infiltration without eosinophils, which were consistent with nonspecific interstitial pneumonia.
Angiography ; Biopsy ; Bone Marrow ; Brain ; Carotid Artery, Internal ; Cerebral Infarction ; Constriction, Pathologic ; Eosinophilia ; Eosinophils ; Fibrosis ; Humans ; Hypereosinophilic Syndrome* ; Liver ; Lung Diseases, Interstitial ; Lung* ; Middle Aged