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Sprengel Deformity: Morphometric Assessment and Surgical Treatment by the Modified Green Procedure

Wada, Akifusa MD, PhD*; Nakamura, Tomoyuki MD, PhD; Fujii, Toshio MD*; Takamura, Kazuyuki MD, PhD; Yanagida, Haruhisa MD; Yamaguchi, Toru MD; Kubota, Hideaki MD, PhD*; Oketani, Yutaka MD*

Journal of Pediatric Orthopaedics: January 2014 - Volume 34 - Issue 1 - p 55–62
doi: 10.1097/BPO.0b013e318288b407
Upper Extremity

Background: We evaluated the pathologic anatomy of the Sprengel deformity using radiographs, 3-dimensional computed tomography (3D-CT), and magnetic resonance imaging (MRI), and reviewed our results of the modified Green procedure.

Methods: Between 2002 and 2009, 23 scapulae in 22 patients were treated. The average age at the time of surgery was 3.4 years (range, 1.9 to 7.1 y). The outcome of surgery was assessed on the basis of changes in shoulder abduction and the radiographic findings using Cavendish classification, Rigault classification, scapular elevation, and medialization. Preoperative appearance was classified as grade III in 13 cases and grade IV in 10 cases according to the Cavendish classification, and as grade II in 4 cases and grade III in 19 cases according to the Rigault classification. Using 3D-CT, we assessed the height to width ratio on the scapular posterior view, the superior displacement ratio and rotational difference on the trunk posterior view, and the anterior curvature of the supraspinous portion on the scapular medial view.

Results: The average follow-up postoperative period was 4.4 years (range, 2.2 to 8.7 y). Postoperatively, the shoulder abduction improved well, with a mean improvement of 63 degrees. Improvement of at least 1 Cavendish grade and 1 Rigault grade was attained in all cases. On preoperative 3D-CT, the mean height to width ratio of the affected scapula was significantly smaller than that of the contralateral scapula. There was an inverse relationship between the superior displacement ratio and the rotational difference. Anterior curvature of the supraspinous portion was seen in all cases. Omovertebral bone was found in 20 cases. MRI identified unossified omovertebral cartilage that was not evident by radiographs or CT. Transient brachial plexus palsy occurred in 2 patients, both of whom recovered within 4 months. Postoperative scapula winging and unsightly scarring were seen in 3 and 8 cases, respectively.

Conclusions: 3D-CT and MRI were helpful in evaluating the pathologic anatomy of the deformity and in planning the surgery. The modified Green procedure provided successful functional and cosmetic results.

Level of Evidence: Level IV.

*Department of Orthopaedic Surgery, Saga Handicapped Children’s Hospital, Saga

Fukuoka Children’s Hospital, Fukuoka, Japan

None of the authors received financial support for this study.

The authors declare no conflict of interest.

Reprints: Akifusa Wada, MD, PhD, Department of Orthopaedic Surgery, Saga Handicapped Children’s Hospital, 2215-27 Kinryu, Kinryu-machi, Saga 849-0906, Japan. E-mail:

© 2014 by Lippincott Williams & Wilkins