Severe thoracolumbar congenital kyphosis treated with single posterior approach and gradual “in situ” correction

Abstract

Background: Congenital kyphosis results from the failed formation of the vertebrae during the embryonic period and may be associated with cardiac, urogenital, or spinal cord anomalies. Surgical treatment is the best choice through anterior, posterior, or both approaches. Objectives: This study aims to evaluate the effect of posterior gradual correction using the “in situ” bender to correct severe thoracolumbar congenital kyphosis with or without osteotomy or excision of the vertebra. Methods: Twenty-five patients with an age range of 2–23 (mean ± SD = 12.58 ± 6.03) years with severe thoracolumbar kyphosis were treated surgically at our institution between 2004 and 2013. Pedicle screwing, osteotomy, and gradual “in situ” bending through the single posterior approach were the choices of treatment. Cobb’s angle, patient’s height, and SRS-22r were used to evaluate the patients preoperatively and postoperatively. Follow-up periods were 35–136 months. Result: Cobb’s angle pre-surgery range was 35–180 (81.48 ± 39.1) degrees improved post-surgery to 0–45 (21.72 ± 13.47) degrees ( p-value <0.0001). The range of patients’ standing height pre-surgery was 79–170 (142.42 ± 24.85) centimeters increased after surgery to 81–175 (147.76 ± 26.33) centimeters ( p-value <0.0001). SRS-22r pre-surgery range was between 2.12 and 3.904 (3.2 ± 0.77) and improved post-surgery to 4.16 and 4.96 (4.59 ± 0.29) ( p-value = 0.046). Conclusion: Gradual correction with the “in situ” bender with or without osteotomy through the single posterior approach can give satisfying clinical (patients’ standing height and SRS-22r scores) and radiological (Cobb’s angle) results to treat severe congenital thoracolumbar kyphosis.

Closing-opening wedge osteotomy for the treatment of congenital kyphosis in children

“…Compared to the VCR, it is less traumatic with minimal complications. [8][9][10][11] However, the technique cannot be used for severe CK because the single-segment transpedicular osteotomy for the lumbar spine is less than 30°and for the thoracic spine is less than 25°. 12,13 COWO has been proven to achieve substantial correction of severe sagittal imbalance at a single level.…”

Proposal for a Treatment-oriented Classification System for Congenital Kyphosis in Children

“…2,3 Surgical intervention is necessary in most cases, and the single posterior procedure, which reconstructs the spinal balance using appropriate osteotomies, is currently the most popular procedure. [4][5][6] Winter's classification system for CK is the system most commonly used by spinal surgeons. The system describes three types: Type I shows failure of formation (an absence of vertebral bodies), Type II shows failure of segmentation, and Type III shows both failure of formation and segmentation.…”

“…2,3 Surgical intervention is necessary in most cases, and the single posterior procedure, which reconstructs the spinal balance using appropriate osteotomies, is currently the most popular procedure. 4–6…”