Prevention of the crankshaft phenomenon with anterior spinal epiphysiodesis in surgical treatment of severe scoliosis of the younger patient.

The aim of this study was to determine whether an anterior approach to the spine with a fusion of the growth centers of the anterior column of the spine, simultaneous by with a posterior fusion and instrumentation of the spine, in young patients with severe scoliosis who have considerable remaining growth, leads to prevention of the crankshaft phenomenon. Twelve patients who have had anterior fusion of the spine associated with posterior fusion and instrumentation of the spine were studied. In 10 of them, growth progression was demonstrated by modification of the Risser sign; for these patients no important progression of the spinal deformity was noted. One patient had no progression of the Risser sign and no progression of spinal deformity. One patient had progression of spinal deformity due to the disruption of the sacral anchorage of instrumentation. We think that this procedure leads to the prevention of the crankshaft phenomenon, and we recommend this procedure in young patients with severe scoliosis and considerable remaining growth. It must include all intervertebral levels of the rigid segment of the curve.