Outcome of Mears procedure for Sprengel’s deformity

Abstract

Background:Sprengel’s shoulder is characterized by scapular maldescent and malposition, causing restriction of shoulder and cervical spine movements. It is associated with a variety of other congenital anomalies. Various surgical procedures have been described to treat this anomaly with no consensus as to the surgical procedure of choice. We report the results of the Mears procedure in the treatment of Sprengel’s shoulder.Materials and Methods:Seven children between the age group of two and six years were treated for Sprengel’s deformity, with omovertebral bar, and other congenital anomalies. The Cavendish score and Rigault radiological score were used to assess the severity of the deformity, and the position of the scapula relative to the cervical spine, respectively. The Mears procedure involved scapular osteotomy, par tial scapular excision, and release of a long head of triceps. Clavicular osteotomy was done only in two cases to decrease the risk of traction injury to the brachial plexus. Postoperatively, the patients were immobilized in a shoulder sling and range of motion exercises were started as early as possible. The patients were followed regularly at six weeks, three months and regularly at six-months interval.Results:The mean improvement in flexion and abduction was 45 ° (40 – 70 °) and 50 ° (40 – 70 °), respectively, which was the combined glenohumeral and thoracoscapular movement. The cosmetic and functional improvement by this procedure was acceptable to the patients. Minor scar hypertrophy was seen in two cases.Conclusion:The Mears procedure gives excellent cosmetic and functional results. This procedure addresses the functional aspect of the deformity and is much more acceptable to the patient and parents.

Surgical Treatment of Sprengel’s Deformity: A Systematic Review and Meta-Analysis

“…Ten papers [ 2 , 13 , 18 , 34 , 39 , 40 , 43 , 51 , 54 , 56 ] reported neither of them, whereas Khairouni et al [ 50 ] described a personal score that analyzed the position of the scapula based on the vertebral level. The mentioned studies reported the same scores as well in the postoperative assessment, except Bhasker [ 41 ], who did not report the postoperative Rigault classification. Only two papers used patient-reported postoperative scores for clinical and functional assessment, such as the DASH Score [ 58 ], the SST Score [ 16 , 58 ] and the PODCI score [ 16 ], whereas most studies reported only subjective evaluations.…”

“…Most studies reported the patients’ sex, except three [ 34 , 43 , 57 ], and the affected side, except eight [ 21 , 23 , 43 , 47 , 50 , 54 , 57 , 59 ]. In the preoperative evaluation, 28 studies classified patients according to the Cavendish clinical scoring system [ 2 , 9 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 33 , 35 , 36 , 37 , 38 , 41 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 52 , 53 , 55 , 58 , 59 , 60 ] and 15 studies [ 14 , 15 , 16 , 17 , 19 , 21 , 32 , 36 , 41 , 45 , 48 , 53 , 57 ,…”

“…Twenty-three studies (441 patients) reported the grade of deformity, according to the Cavendish classification [ 9 , 14 , 16 , 17 , 19 , 20 , 21 , 23 , 35 , 36 , 37 , 41 , 42 , 44 , 45 , 46 , 48 , 52 , 53 , 55 , 58 , 59 , 60 ]. Ninety-seven patients (22%) were grade 4, 283 patients (64.2%) were grade 3, 51 patients (11.5%) were grade 2 and 10 patients (2.3%) were grade 1.…”

“…Ninety-seven patients (22%) were grade 4, 283 patients (64.2%) were grade 3, 51 patients (11.5%) were grade 2 and 10 patients (2.3%) were grade 1. Fifteen studies (283 patients) used Rigault’s classification [ 14 , 15 , 16 , 17 , 19 , 21 , 32 , 36 , 41 , 45 , 48 , 53 , 57 , 58 , 60 ]: 41% reported score 3 (116/283), 59% score 2 (167/283), whereas no patient had score 1 at the preoperative assessment. Only two papers did not report any vertebral-shoulder connection in their patients [ 9 , 40 ]; the other studies identified a connection between the scapula and spine in 305 patients (46.9%), represented by an omovertebral bone bar (264 patients), fibrous bridge (22 cases) or cartilaginous bar (19 cases).…”

“…The original and modified Green procedure was reported in 14 papers [ 14 , 15 , 23 , 34 , 35 , 37 , 39 , 40 , 44 , 45 , 47 , 48 , 51 , 53 ], accounting for 280 patients; Woodward’s procedure (or modified techniques) was performed in 18 studies [ 2 , 9 , 16 , 17 , 23 , 32 , 33 , 42 , 43 , 46 , 49 , 50 , 54 , 55 , 56 , 57 , 58 , 60 ], accounting for 234 patients. Bhasker [ 41 ], Masquijo [ 19 ] and Mears [ 18 ] treated 29 patients overall with Mears’s technique. Sixty-three patients were treated with VSO [ 36 , 38 , 52 , 59 ]; only Greitemann [ 23 ] reported 10 patients treated with the König–Wittek procedure [ 22 ], whereas 38 patients were treated with a simpler partial scapulectomy [ 20 , 21 , 23 , 32 ].…”