Sprengel Deformity Scapuloplexy

Operative Indications (Relative)

Abduction <90°
Omovertebral connection constraining scapulothoracic motion (Figures 17.1 and 17.2)
Cavendish III or IV deformity (Figure 17.3)
In conjunction with congenital scoliosis surgery (Figure 17.4)

Equipment

Preoperative 3-dimensional (3D) computed tomography (CT) imaging for planning of resection of omovertebral connection and superiomedial pole and scapula superior to spine safely required (Figure 17.5)
Spine fusion table with padding and head support

Extensive gel pads for bony prominences and neurovascular protection

Figure 17-1 ▪ A, Preoperative patient with obvious left Sprengel deformity, elevated scapula and omovertebral bony connection. B, Omovertebral bone connection outlined by the dotted curve. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Figure 17-2 ▪ Three-dimensional (3D) imaging of right elevated scapula and omovertebral bony connection. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Figure 17-3 ▪ A, Sprengel deformity with very high riding scapula on 3-dimensional (3D) imaging. B, More complex omovertebral bone connection to cervical spine. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Head support and neck positioning prone
- Mirror to monitor endotracheal tube
Complete orthopedic instrument kit
Neuromonitoring if omovertebral bone extends inside laminae to spinal canal (Figure 17.6)

Positioning

Prone with head support in neutral neck position (Figure 17.7)
Affected arm prepped completely free for mobility in operation (Figure 17.8)
Padded spinal table protecting bilateral brachial plexus
Gel pads protecting all bony prominences and neurovascular structures

Figure 17-4 ▪ Sprengel deformity associated with scoliosis treated surgically. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Figure 17-5 ▪ Omovertebral connection to laminae noted by an arrow on lateral (A) and anteroposterior (AP) (B) images. (Courtesy of Children’s Orthopaedic Surgery Foundation.)
Often Klippel-Feil association with foreshortened neck and high riding scapula requires extensive shaving of hair up into occiput (Figure 17.9)
Posterior midline prepped extensively from occiput to lower thoracic region (Figure 17.10)
Include full view of full scapula and outline them with surgical marking pen

Figure 17-6 ▪ Patient prone, prepped, and draped with neuromonitoring wires connected to right opeative side that is draped free. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Figure 17-7 ▪ Patient positioned prone on spinal table with proper padding and neck and arm positioning and support. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

Figure 17-8 ▪ Affected right arm completely prepped and draped free for mobility during case. (Courtesy of Children’s Orthopaedic Surgery Foundation.)

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