Can a culture of team psychological safety and MDT proforma improve team performance and patient outcomes in spinal MDTs?

PURPOSE: Spinal multidisciplinary teams (MDTs) are now standard of care for complex patient management in tertiary spinal units. This study investigates whether a scheduling proforma, and cultural change to the team that promotes psychological safety, can improve spinal MDT effectiveness for team members and patients. METHODS: Retrospective cohort study including 165 spinal MDT patients before and after intervention. The intervention was use of a scheduling proforma and team learning to promote a culture of psychological safety. Data on accident and emergency (A&E) attendances, unplanned emergency admissions and post-operative 30-day readmissions were collected. At the team level, data were collected from 16 MDT participants using the MDT Observational Assessment Rating Scale (MDT-OARS), which measures MDT effectiveness. RESULTS: Pre-intervention MDT-OARS was 28. Analysis of 80 patients demonstrated there were six A&E attendances, three unplanned emergency admissions and four post-operative 30-day re-admissions. Post-intervention MDT-OARS was 38 (p < 0.05). Analysis of 85 patients demonstrated there were three A&E attendances, one unplanned emergency admission and one post-operative re-admission. CONCLUSIONS: Team culture that promotes psychological safety, along with use of a scheduling proforma, can improve MDT effectiveness for participants in spinal MDTs.

Recommendations for Lengthening of Magnetically Controlled Growing Rods in Children With Pacemakers.

PURPOSE OF THE STUDY: Pacemakers are currently identified as a contraindication for the use of magnetic growth rods (MGRs). This arises from concern that magnetic fields generated by the MGR external remote controller (ERC) during lengthening procedures may induce pacemaker dysfunction. We investigated (1) whether MGR lengthening affects pacemaker function, and (2) if the magnetic field of a pacemaker affects MGR lengthening. METHODS: MGRs were tested in conjunction with an magnetic resonance imaging-compatible pacemaker, which was connected to a virtual patient under continuous cardiac monitoring. To determine whether pacemaker function was affected during MGR lengthening, the electrocardiogram trace was monitored for arrhythmias, whereas an ERC was applied to lengthen the MGRs at varying distances from the pacemaker. To investigate if MGR lengthening was affected by the presence of a pacemaker, at the start and end of the experiment, the ability of the rods to fully elongate and shorten was tested to check for conservation of function. RESULTS: When the pacemaker was in normal mode, <16 cm away from the activated ERC during MGR lengthening, pacemaker function was affected by the ERC's magnetic forces. At this distance, prophylactically switching the pacemaker to tonic mode before lengthening prevented occurrence of inappropriate pacing discharges. No deleterious effect of the pacemaker's magnetic field on the MGR lengthening mechanism was identified. CONCLUSIONS: Magnetic resonance imaging-compatible pacemakers appear safe for concomitant use with MGRs, provided a pacemaker technician prophylactically switches the pacemaker to tonic function before outpatient lengthening procedures. CLINICAL RELEVANCE: This experiment was designed to provide the first safety information on MGR lengthening in children with pacemakers. Although currently a rare clinical scenario, with increasing use of MGRs, this clinical scenario may arise more frequently in the future.

Is balloon kyphoplasty safe and effective for cancer-related vertebral compression fractures with posterior vertebral body wall defects?

BACKGROUND AND OBJECTIVES: Balloon kyphoplasty (BKP) is a percutaneous treatment for cancer-related vertebral compression fractures (VCF). Posterior vertebral body wall (PVBW) involvement is considered a contraindication for BKP. This study assesses whether BKP is safe and effective for cancer-related VCFs involving the PVBW. METHODS: This study analyzed data on 158 patients with 228 cancer-related VCFs who underwent BKP. One hundred and twelve patients had VCFs with PVBW defects, and 46 had VCFs with no PVBW defect. Outcomes were assessed preoperatively and at 3 months. RESULTS: In the PVBW defect group, mean pain score decreased from 7.5 to 3.6 (P < 0.001), EQ5D increased from 0.39 to 0.48 and Oswestry Disability Index (ODI) decreased from 50 to 42. Cement leaks occurred in 31%. In the PVBW intact group, mean pain decreased from 7.3 to 3.3 (P < 0.001), EQ5D increased from 0.35 to 0.48 (P < 0.001), and ODI decreased from 53 to 50. Cement leaks occurred in 20%. No significant difference was observed in functional improvements between groups. Radiographically kyphotic angle and anterior and middle vertebral body heights were significantly worse in the PVBW defect group (P < 0.05). CONCLUSIONS: BKP can alleviate pain and improve QoL and function in patients with cancer-related VCFs with PVBW defects with no appreciable increase in risk. J. Surg. Oncol. 2016;113:835-842. © 2016 Wiley Periodicals, Inc.

A Preliminary Study to Assess Whether Spinal Fusion for Scoliosis Improves Carer-assessed Quality of Life for Children With GMFCS Level IV or V Cerebral Palsy.

BACKGROUND: Scoliosis affects 50% of children with Gross Motor Function Classification System (GMFCS) level IV or V cerebral palsy (CP). In children with complex neurodisability following intervention, the WHO considers quality of life (QoL) should be assessed to aid decision-making and assess the effects. This study assesses whether scoliosis surgery improves carer-assessed QoL for children with severe CP. METHODS: Retrospective review of 33 children (16 male:17 female) with GMFCS level IV/V CP and significant scoliosis. Fifteen underwent observational treatment during childhood, and 18 underwent surgery. Questionnaire and radiographic data were recorded over a 2-year period. The carer-completed Caregiver Priorities and Child Health Index of Life with Disabilities (CPCHILD) questionnaire was used to assess QoL. RESULTS: In the observational group, Cobb angle and pelvic obliquity increased from 46 (40 to 60) and 8 degrees (0 to 28) to 62 (42 to 94) and 12 degrees (1 to 35). Mean CPCHILD score decreased from 50 (30 to 69) to 48 (27 to 69) (P<0.05). In the operative group, Cobb angle and pelvic obliquity decreased from 78 (52 to 125) and 14 degrees (1 to 35) to 44 (16 to 76) and 9 degrees (1 to 24). Mean CPCHILD score increased from 45 (20 to 60) to 58 (37 to 76) (P<0.05). Change in pain, and not presence of associated impairments, was the most significant factor affecting QoL changes for children in both groups. There was no difference in mobility, GMFCS level, feeding, or communication in either group before and after treatment. CONCLUSIONS: Nonoperative treatment for children with GMFCS level IV/V CP and a significant scoliosis was associated with a small decrease in carer-assessed QoL over 2 years. Spinal fusion was associated with an increase in QoL. Change in pain was the most significant factor affecting QoL changes, and is therefore an important factor to consider when deciding upon surgery. LEVEL OF EVIDENCE: Level III-therapeutic retrospective study.

Reverse shoulder arthroplasty in 41 patients with cuff tear arthropathy with a mean follow-up period of 5 years.

BACKGROUND: Reverse shoulder arthroplasty (RSA) is an accepted treatment for patients with pseudoparalysis due to cuff tear arthropathy. There have been limited studies with midterm clinical and radiologic results. We present our results for a single surgeon from a district general hospital. METHODS: Forty-one consecutive Delta III RSAs were performed by an anterosuperior approach in 37 patients (29 women and 8 men) with pseudoparalysis due to cuff tear arthropathy. The patients' mean age was 79 years (range, 68-91 years). The mean follow-up period was 5 years. All patients were available for final review, and none were lost to follow-up. RESULTS: The mean age-adjusted Constant and Oxford scores improved from 34.2 points to 71.0 points and 15 points to 33 points, respectively. Mean abduction and forward flexion improved from 64° to 100° and 55° to 110°, respectively. Scapular notching was seen in 68% of patients, but there was no deterioration in function or satisfaction scores. Stress shielding of the proximal humerus was seen in 10% of patients. One patient underwent revision to a hemiarthroplasty because of glenoid component failure after a fall. There were no early postoperative dislocations in our series. CONCLUSION: RSA for pseudoparalysis due to cuff tear arthropathy provides good functional results at 5 years; however, there is a high rate of scapular notching, which does not seem to affect overall functional outcomes.

Complex shoulder arthroplasty in patients with skeletal dysplasia can decrease pain and improve function.

BACKGROUND: Patients with skeletal dysplasia are prone to the development of degenerative shoulder disease requiring shoulder arthroplasty at a younger age than in the general population. To date there have been no published reports on the complexities or outcome of shoulder arthroplasty in this unique patient group. METHODS: This is a review of 13 shoulder arthroplasties in 10 patients with skeletal dysplasia with mean follow-up of 7 years (2-17.6 years). There were 4 men and 6 women with a mean age of 53.1 years (23-76 years), mean height of 148 cm (122-177 cm), and mean weight of 60 kg (27-80 kg). RESULTS: The mean Oxford Shoulder Score increased from 13 (5-20) preoperatively to 28 (18-38) at final follow-up. Patients improved significantly in 2 of 8 Short Form 36 health-related quality of life domains: physical function (P = .04) and bodily pain (P = .04). Function was better in those who underwent nonconstrained total shoulder arthroplasty as opposed to hemiarthroplasty. Four (31%) required reoperation: 1 excision of heterotopic ossification, 1 relocation for anterior instability, and 2 revisions for periprosthetic fracture and glenoid erosion. CONCLUSION: Shoulder arthroplasty is effective at relieving pain, optimizing movement, and improving function for patients with skeletal dysplasia; however, compared with the general population, there is a higher complication rate and function is not as good. Furthermore, this procedure is less effective at restoring health-related quality of life than total hip arthroplasty or total shoulder arthroplasty performed for osteoarthritis in the general population. Custom implants may be required to compensate for short stature and rotator cuff and glenoid deficiency.

Custom cementless THA in patients with Legg-Calve-Perthes Disease.

Legg-Calve-Perthes disease is characterized by osteonecrosis of the femoral head during childhood. Outcomes of total hip arthroplasty (THA) for these patients are less satisfactory than for those with primary osteoarthritis, often complicated by young patient age, multi-planar deformities and previous childhood surgery. To our knowledge no one has reported the long-term outcomes of cementless custom-made THA in patients with Legg-Calve-Perthes disease. We reviewed 15 THAs with an average follow-up of ten years. Survivorship rates of the femoral and acetabular components were 100% and 79% respectively. Mean Harris Hip Scores improved from 41 preoperatively to 80 at final follow-up. With excellent functional outcome, custom-made cementless prostheses should be considered as a treatment option for osteoarthritis secondary to Legg-Calve-Perthes disease in the presence of abnormal proximal femoral and acetabular anatomy.

Clavicle lengthening by distraction osteogenesis for congenital clavicular hypoplasia: case series and description of technique.

BACKGROUND: Malformation and hypoplasia of the clavicle can result in pain, impaired function, restricted shoulder movement, subjective feeling of instability, and cosmetic deformity. There are no reports of clavicle lengthening by osteotomy and distraction osteogenesis (DO). METHODS: This is a retrospective review of 5 patients (7 clavicles) who underwent clavicle lengthening by DO using a monolateral external fixator for clavicular hypoplasia. There were 3 males and 2 females with the mean age of 15 years (9 to 23 y) and mean follow-up of 35 months (12 to 66 mo). Preoperative diagnoses included Klippel-Feil syndrome, cleidocranial dysplasia with hemihypertrophy and torticollis, congenital myopathy and Noonans syndrome, and obstetric brachial plexus injury. RESULTS: Mean length gained was 31 mm (15 to 41 mm) that represents an average of 24.7% of overall bone length. Mean time in fixator was 174 days (161 to 263 d) and mean external fixation index was 56 d/cm. Two patients required internal fixation after fixator removal to consolidate union and 1 required additional internal fixation for atrophic regeneration. Mean preoperative oxford shoulder score improved from 28.5 to 41 and all patients were extremely satisfied with their result. Two patients developed pin-site infections. CONCLUSIONS: Clavicular lengthening by DO for congenital clavicular hypoplasia is a previously unreported technique that enables gradual correction of deformity without risking brachial plexus traction injury after acute correction. It has the potential to improve shoulder pain, function, range of movement, and cosmesis. Distraction ≥25% of overall bone length may require additional plate fixation to consolidate union. LEVEL OF EVIDENCE: Level IV-therapeutic study.

Cementless surface replacement arthroplasty of the shoulder for osteoarthritis: results of fifty Mark III Copeland prosthesis from an independent center with four-year mean follow-up.

PURPOSE: Few studies have reported the outcome of cementless surface replacement (CSRA). We initiated this study to analyze results of the Mark III Copeland prosthesis used as a hemiarthroplasty in patients with glenohumeral osteoarthritis. MATERIALS AND METHODS: We retrospectively reviewed 53 consecutive Mark III Copeland CRSA hemiarthroplasties in 46 patients (30 women, 16 men) with glenohumeral osteoarthritis from an independent institution by a single surgeon. Patients were a mean age of 69 years (range, 45-94 years). Mean follow-up was 4.2 years (range, 2-8 years). Fifty uncemented hemiarthroplasties were available for review. RESULTS: Mean (range) age-adjusted Constant and Oxford scores improved from 38.5 (15-61) and 22 (9-31) to 75.1 (38-87) and 42 (18-48), respectively. Anterosuperior escape of the humeral head developed in 1 patient who had an oversized humeral component due to progressive rotator cuff failure at 2 years. Moderate glenoid erosion was present in 12% and correlated with oversizing of the humeral component. There was one revision to a stemmed cemented hemiarthroplasty for periprosthetic fracture. No patients have required revision for aseptic loosening, rotator cuff failure, or glenoid erosion to date. CONCLUSIONS: Copeland surface replacement hemiarthroplasty for glenohumeral osteoarthritis can provide functional results similar to modular stemmed prostheses, with a relatively low revision rate at 4.2 years of follow-up; however, there is high rate of glenoid erosion that may complicate future revision surgery, and we did not achieve the same functional improvement as that achieved from the designer's institution.

Causes of a painful total knee arthroplasty. Are patients still receiving total knee arthroplasty for extrinsic pathologies?

PURPOSE: Whilst patients undergoing total knee replacements generally have good relief of their symptoms, up to 20% complain of persisting pain. Revision rates have therefore been rising, particularly so for unexplained pain. We reviewed the causes of painful total knee replacements including extrinsic causes. METHODS: Forty-five consecutive patients referred to our department with painful total knee replacement were reviewed with our standard protocol, including history and examination, inflammatory markers and radiological studies including radiographs of the hip and knee and computed tomography scan of the knee joint. RESULTS: Of the 45 patients, 15 patients had degenerative hip and lumbar spine disease which resolved after injections of the relevant joints. Nine patients had unexplained pain. CONCLUSIONS: Patients may still be undergoing knee arthroplasty for degenerative lumbar spine and hip osteoarthritis. We suggest heightened awareness at pre- and post-operative assessment and thorough history and examination with the use of diagnostic injections to identify the cause of pain if there is doubt.

Proximal ulna endoprosthetic replacement for bone tumours in young patients.

PURPOSE: The optimal reconstructive method after resection of malignant bone tumours of the proximal ulna is unknown.We report the outcome of endoprosthetic replacement in a young patient population. METHODS: This was a retrospective review of four patients[three males and one female; mean age 17.5 (range 11­31)years] who underwent limb salvage with a proximal ulnar endoprosthetic replacement following excision of malignant bone tumour. Mean follow-up was 85 (range 14­194) months. RESULTS: All patients were alive at final follow-up and reported an improvement in pain. One patient required transhumeral amputation for intralesional excision complicating a local recurrence at one month. Two patients developed fixed flexion deformities of the elbow, one of whom required radial-head excision. Mean Musculoskeletal Tumour Society (MSTS)score and Toronto Extremity Salvage Score (TESS) were 27(range 25­28) and 81 (73­88), respectively. CONCLUSIONS: Custom-made proximal ulna endoprosthetic replacement following resection of malignant bone tumours in young patients provides a stable reconstruction option with satisfactory function and without apparent compromise in patient survival.

The effect of smoking on fracture healing and on various orthopaedic procedures.

Ten percent of all fractures lead to problems with healing. Smoking is said to be a cause. There are 13.5 million smokers in the U.K. Healing of tibial fractures, for instance, requires two more months in smokers. Nicotine, carbon monoxide and hydrogen cyanide are most often seen as the offenders, among the 4000 chemicals found in cigarettes. Many studies plead for the negative effect of smoking in general, yet there is uncertainty as to the precise role of nicotine. The authors recommend that patients should attempt smoking cessation therapy before elective orthopaedic treatment.

Custom cementless THA in patients with skeletal dysplasia results in lower apparent revision rates than other types of femoral fixation.

BACKGROUND: Patients with skeletal dysplasia are prone to degenerative hip disease thus requiring THA at a younger age than the general population. This is a technically demanding procedure with high complication and revision rates. Achieving good femoral fixation can be challenging because of the abnormal features of the hip. QUESTIONS/PURPOSES: We therefore determined: (1) survivorship, (2) function, (3) radiographic findings, and (4) complications associated with a cementless custom-made femoral component used in THAs for patients with skeletal dysplasia and compared these parameters with those from other types of femoral fixation. PATIENTS AND METHODS: Between 1992 and 2005, 40 THAs were performed in 25 patients with skeletal dysplasia using custom-made cementless femoral components. There were 15 men and 10 women with a mean age of 37.5 years (range, 18-61 years) and a mean height of 145 cm (range, 120-173 cm). Patients were followed clinically and radiographically for a minimum of 4.3 years (mean, 10.1 years; range, 4.3-18.2 years). RESULTS: The survivorship rates for the femoral and acetabular components were 92% and 70%, respectively, at 220 months. Revision arthroplasty was performed in four of 40 hips (10%). In two, the acetabular component was revised for aseptic loosening, one had both components revised for aseptic loosening, and one had an isolated femoral component revision for deep infection. The mean Harris hip score improved from 41 (range, 27-57) preoperatively to 80 (range, 51-94) at final followup. There were two intraoperative proximal femoral fractures and one dislocation. CONCLUSIONS: When compared with studies with equal followup, custom-made cementless components in THAs for patients with skeletal dysplasia apparently had lower revision and complication rates with comparable function and higher midterm survival.

Screening and treatment in developmental dysplasia of the hip-where do we go from here?

PURPOSE: Developmental dysplasia of the hip (DDH) is a leading cause of disability in childhood and early adult life. Clinical and sonographic screening programmes have been used to facilitate early detection but the effectiveness of both screening strategies is unproven. This article discusses the role for screening in DDH and provides an evidence-based review for early management of cases detected by such screening programmes. METHODS: We performed a literature review using the key words 'hip dysplasia,' 'screening,' 'ultrasound,' and 'treatment.' RESULTS: The screening method of choice and its effectiveness in DDH still needs to be established although it seems essential that screening tests are performed by trained and competent examiners. There is no level 1 evidence to advise on the role of abduction splinting in DDH although clinicians feel strongly that hip instability does improve with such a treatment regime. The definition of what constitutes a pathological dysplasia and when this requires treatment is also poorly understood. CONCLUSION: Further research needs to establish whether early splintage of clinically stable but sonographically dysplastic hips affects future risk of late-presenting dysplasia/dislocation and osteoarthritis. There is a need for high quality studies in the future if these questions are to be answered.

Custom endoprosthetic reconstruction for malignant bone disease in the humeral diaphysis.

The optimal reconstructive method following segmental resection of malignant tumours in the humeral diaphysis is unknown as there are no prospective long-term studies comparing biologic with endoprosthetic reconstruction. This is a retrospective review of 13 patients who, between 1995 and 2010, had undergone limb salvage at our institution using a custom-made humeral diaphyseal endoprosthetic replacement following excision of malignant bone disease. There were 9 males and 4 females with a mean age of 35 years at the time of surgery (range: 10 to 78). Mean follow-up was 56.8 months (range: 5 to 148). Cumulative patient survival was 75% at 10 years. Implant survival, with removal of the endoprosthesis or part of it for any reason as an end point, was 47% at 10 years. Seven patients required revision (54%). Complications included metastases in four, aseptic loosening in four, peri-prosthetic fracture in two and local recurrence in two. Mean MSTS and TESS scores were 23 (18 to 27) and 67% (52-80) respectively. Custom-made humeral diaphyseal replacement following resection of malignant bone tumours provided functional results superior to amputation, without an obvious compromise in patient survival. There was a relatively high revision rate for aseptic loosening and peri-prosthetic fracture and patients should be counselled about this preoperatively.

Modular proximal femoral replacement in salvage hip surgery for non-neoplastic conditions.

Addressing severe proximal femoral bone loss in revision hip surgery is a challenging reconstructive problem. The use of modular proximal femoral megaprostheses is one of many available options to address this. This is a retrospective review of 15 patients who had undergone limb salvage at our institution using a modular proximal femoral replacement. There were 8 males and 7 females with a mean age of 67 years (34 to 85) and a mean follow-up of 60 months (1 to 99). Indications included re-implantation for deep infection in nine patients, aseptic loosening in three, periprosthetic fracture in two and painful excision arthroplasty in one. Mean Harris hip score increased from 28 (13 to 49) pre-operatively to 69 (39 to 85) at final follow-up (paired t-test, p < 0.0001) and mean Toronto Extremity Salvage score increased from 26% (14 to 40) to 71% (35 to 82) (paired t-test, p < 0.0001). Prosthesis survival with revision as the endpoint was 87% at 5 years. There were two dislocations (14%) and there was failure to eradicate deep infection in two. Modular proximal femoral replacement provided good function and versatility with an acceptable complication rate for patients with severe proximal femoral bone loss with or without infection.

A Review of the Surgical Management of Extrathoracic Solitary Fibrous Tumors.

OBJECTIVES: Extrathoracic solitary fibrous tumors (ESFTs) are rare low-to-intermediate grade spindle-cell neoplasms of pluripotent fibroblastic or myofibroblastic origin. This review explores prognostic factors in the management of ESFTs and provides guidance on optimal treatment regimens based on the current literature. PATIENTS AND METHODS: Electronic searches were performed using MEDLINE, Embase, and the Cochrane library to identify studies on prognostic factors in the management of ESFTs published between January 1970 and June 2016. The literature search and review process identified 100 articles that were included in this review article. This included both surgical and nonsurgical studies on the management of ESFTs. RESULTS: Surgical excision with wide resection margins forms the mainstay of treatment and provides optimal long-term oncological outcomes. Large tumor size (>5 to 10 cm diameter), inadequate resection margins, malignant histologic features, dedifferentiation, and tumor location within the abdomen/pelvis are associated with adverse oncological outcomes. Radiotherapy may be used for preoperative tumor shrinkage and/or as adjuvant therapy in patients with malignant disease or incomplete surgical margins. Chemotherapy with molecular-targeted therapies has produced promising results and the results of further phase 2 trials are awaited. CONCLUSIONS: Routine long-term follow-up is essential for benign and malignant disease to enable early detection and treatment of recurrent disease.

The 2016 Austrian-Swiss-German Fellowship.

The Austrian-Swiss-German (ASG) Traveling Fellowship, which began in 1979, is an annual exchange of surgeons between the German-speaking countries of Austria, Switzerland, and Germany and the English-speaking countries of the United States, England, and Canada. In 2016, 4 fellows were chosen to participate in the fellowship, including Eric Edmonds from the University of California, San Diego; Simon Mears from the University of Arkansas for Medical Sciences; Mathew Sewell from the James Cook University in Middlesbrough, England; and Andrea Veljkovic from the University of British Columbia in Vancouver.

Anterior lumbar discectomy and fusion for acute cauda equina syndrome caused by recurrent disc prolapse: report of 3 cases.

There is a lack of information and consensus regarding the optimal treatment for recurrent disc herniation previously treated by posterior discectomy, and no reports have described an anterior approach for recurrent disc herniation causing cauda equina syndrome (CES). Revision posterior decompression, irrespective of the presence of CES, has been reported to be associated with significantly higher rates of dural tears, hematomas, and iatrogenic nerve root damage. The authors describe treatment and outcomes in 3 consecutive cases of patients who underwent anterior lumbar discectomy and fusion (ALDF) for CES caused by recurrent disc herniations that had been previously treated with posterior discectomy. All 3 patients were operated on within 12 hours of presentation and were treated with an anterior retroperitoneal lumbar approach. Follow-up ranged from 12 to 24 months. Complete retrieval of herniated disc material was achieved without encountering significant epidural scar tissue in all 3 cases. No perioperative infection or neurological injury occurred, and all 3 patients had neurological recovery with restoration of bladder and bowel function and improvement in back and leg pain. ALDF is one option to treat CES caused by recurrent lumbar disc prolapse previously treated with posterior discectomy. The main advantage is that it avoids dissection around epidural scar tissue, but the procedure is associated with other risks and further evaluation of its safety in larger series is required.

Long-term clinical and radiological outcomes of Copenhagen syndrome with 19 affected levels: a case report.

BACKGROUND CONTEXT: Copenhagen syndrome, or progressive noninfectious anterior vertebral fusion, is a rare disorder of unknown etiology that usually presents with thoracolumbar kyphosis in childhood. There have been no long-term reports on outcome in children with multiple affected levels with longitudinal imaging from infancy to adulthood. PURPOSE: The purpose of this study was to report the long-term outcome of nonoperative management of a child with Copenhagen syndrome affecting 19 vertebral levels. STUDY DESIGN: This study is a case report. METHODS: The study included longitudinal clinical and radiological follow-ups. RESULTS: A 1-year-old female presented with thoracolumbar kyphosis. Plain radiographs and magnetic resonance imaging demonstrated kyphosis associated with anterior disc space narrowing plus T11-T12 and L2-L3 vertebral end-plate abnormalities. Initial treatment with a plaster jacket followed by brace failed to prevent progressive vertebral involvement and kyphosis during childhood. At skeletal maturity, no further levels became involved, and progression was halted. In total, 19 levels showed anterior fusion. CONCLUSIONS: This case describes the long-term outcome of nonoperative management for progressive noninfectious anterior vertebral fusion affecting multiple levels. Extensive vertebral involvement does not always require surgical intervention. There is a need for future research on the prognostic indicators for progression and long-term outcome.