Surgical treatment of severe congenital thoracolumbar kyphosis through a single posterior approach

Abstract

A combined anterior and posterior surgical approach is generally recommended in the treatment of severe congenital kyphosis, despite the fact that the anterior vascular supply of the spine and viscera are at risk during exposure. The aim of this study was to determine whether the surgical treatment of severe congenital thoracolumbar kyphosis through a single posterior approach is feasible, safe and effective. We reviewed the records of ten patients with a mean age of 11.1 years (5.4 to 14.1) who underwent surgery either by pedicle subtraction osteotomy or by vertebral column resection with instrumented fusion through a single posterior approach. The mean kyphotic deformity improved from 59.9° (45° to 110°) pre-operatively to 17.5° (3° to 40°) at a mean follow-up of 47.0 months (29 to 85). Spinal cord monitoring was used in all patients and there were no complications during surgery. These promising results indicate the possible advantages of the described technique over the established procedures. We believe that surgery should be performed in case of documented progression and before structural secondary curves develop. Our current strategy after documented progression is to recommend surgery at the age of five years and when 90% of the diameter of the spinal canal has already developed.

Burden of disease of reoperations in instrumental spinal surgeries in Germany

“…Furthermore, spinerelated diseases such as spondylolisthesis, scoliosis, kyphosis, or spinal stenosis, are possible indications for ISS [1]. Due to the variety of indications, patients with the need for instrumental spinal surgeries are very heterogeneous and may vary from small children to frail elderly people [2][3][4][5][6][7][8].…”

Can Intraoperative Spinal Cord Monitoring Reliably Help Prevent Paraplegia During Posterior Vertebral Column Resection Surgery?

“…Spiro et al [22] reported their experience of surgically treating 10 congenital thoracolumbar kyphosis patients with all-posterior three-column osteotomies. In their series, they used MEP and SSEP and noted reduction in amplitude in two cases (20%) as a result of bulging of the dura posteriorly that required further posterior decompression with subsequent normalization of data.…”

Letter to the Editor. Pediatric thalamic tumors

“…This creates a potential bias, because presumably the patients with better outcomes (i.e., those with symptom resolution, normal wound healing, and no concern for complications) are those who would not otherwise follow up past their initial wound check evaluation. Given the obvious limitation in follow-up and available postoperative imaging studies, which precluded direct assessment of the development of spinal instability, spinal deformity, and chronic pain, we focused on the assessment of PSM fat infiltration and muscle atrophy, 5,[8][9][10][11][12] as this has been linked to the incidence of chronic back pain and is believed to predispose to spinal instability and progressive dysfunction. 9,10,12 Postlaminectomy spinal deformity is more prevalent in the pediatric population than in adults.…”

“…Given the obvious limitation in follow-up and available postoperative imaging studies, which precluded direct assessment of the development of spinal instability, spinal deformity, and chronic pain, we focused on the assessment of PSM fat infiltration and muscle atrophy, 5,[8][9][10][11][12] as this has been linked to the incidence of chronic back pain and is believed to predispose to spinal instability and progressive dysfunction. 9,10,12 Postlaminectomy spinal deformity is more prevalent in the pediatric population than in adults. Risk factors associated with iatrogenic spinal deformity include the use of adjuvant radiation, multilevel exposure, and the particular level of surgery (incidence is higher for cervical > thoracic > lumbar cases); 3 hence we sought to compare equivalentlevel surgeries.…”