Crankshaft phenomenon refers to continued anterior spinal growth after posterior spinal fusion in a skeletally immature patient, resulting in increased spinal deformity. Risk factors include skeletal immaturity (Risser stage 0, premenstrual, open triradiate cartilage), surgery before the peak growth period (prior to 10 years of age) and large residual curves after initial surgery. The traditional approach for prevention of crankshaft phenomenon is to perform an anterior spinal fusion in addition to posterior spinal fusion in high-risk patients. With use of modern segmental pedicle screw instrumentation, anterior surgery is no longer required in select patients.
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