MODIFIED GREENS PROCEDURE FOR SPRENGEL DEFORMITY Resection of anterior curvature of the supraspinous

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MODIFIED GREENS PROCEDURE FOR SPRENGEL
DEFORMITY Resection of anterior curvature of
the supraspinous portion is important

• Toshio FUJII,
• WADA, A., TAKAMURA, K.,
• YANAGIDA, H., Urano, N.

FUKUOKA CHILDRENS HOSPITAL FUKUOKA, JAPAN
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Our Modified Procedure
Original Greens procedure
Wire Traction
Inferior angle of scapula was sutured to spinous
processes
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MATERIALS(1974 - 2001)
32 Children 32 Shoulders Klippel-Feil
Syndrome29 Children Age at surgery 2y-6y
(Ave. 2y5m) Shoulder abduction 75-120(Ave.
93) Follow-up period 3-20 years (Ave. 9y10m)
Cavendish before surgery
18
0
0 Children
14
Grade 1
Grade 2
Grade 4
Grade 3
4
Lt. SPRENGELS DEFORMITY(2y1m)
16mm
90
CavendishGrade 3
Omovertebral bone
5
Post-Op
Pre-Op
Abd150
Abd 90
Cavendish Grade 3
Cavendish Grade 1
6
Pre-Op
16mm
3mm
Post-Op

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Marked anterior curvature of supraspinous
portion hooked scapula on the shoulder.


Omovertebral bone
Lt. SPRENGELS DEFORMITY
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Marked anterior curvature of the
supraspinous portion


Scapular spine
Normal curvature

Lt
Rt
Lt
Resection of this portion is essential to obtain
good results.
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RESULTS

• Shoulder abduction 93 ? 165
• Cavendish improved well except two

Grade 1
Grade 2
Grade 4
Grade 3
Pre-op (32 shoulders)
14
18
0
0
Post-op
18
0
0
0
0
2
0
12
severe Klippel-Feil syndrome
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CONCLUSION

•    Radical release of strong fibrous bands which
  connected scapula to chest wall, and resection of
  anterior curvature of the supraspinous portion
  which was clearly shown on 3DCT, are essential to
  obtain good results in descending scapula
  procedure. Greens approach makes these
  procedures easier by looking at those points
  directly.