The results of closing wedge osteotomy with posterior instrumented fusion for the surgical treatment of congenital kyphosis

Abstract

Purpose There exist not much data regarding the surgical treatment of pure congenital kyphosis (CK) in the literature. The purpose of this study was to evaluate the results of closing wedge osteotomy with posterior instrumented fusion in patients with congenital kyphotic deformity. Methods We retrospectively evaluated the radiographical results of 10 patients who were subject to closing wedge vertebral osteotomy and posterior instrumented fusion due to CK. The mean age of the patients at surgery was 12.6 ± 3.72 years (range 8-18 years). Radiographical measurements including local kyphosis, correction loss, global kyphosis and sagittal balance values were noted for the preoperative, postoperative and final follow up periods, respectively. The data obtained from those periods underwent statistical analysis. Results Average follow-up period was 51.8 ± 29.32 months (range 26-96 months). The mean local kyphosis angle was 67.7°± 15.64°(range 42°-88°) prior to the surgery, 31.5°± 17.12 (range 14°-73°) following the surgery and 31.9°± 15.98°(range 14°-71°) during the follow up-period, respectively (p \ 0.05). A correction rate of 53.5 % was reported at the final follow up. Average sagittal balance was measured as 33.1 ± 24.48 mm (range 2-77 mm) prior to the surgery, 20.8 ± 15.46 mm (range 5-46 mm) following the surgery (p \ 0.05) and 14.1 ± 9.2 mm (range 0-30 mm) during follow-up period (p [ 0.05).

A New Radiological Sign for Severe Angular Kyphosis: “The Baltalimani Sign”

“…Congenital kyphosis is caused by a mismatch during the final stages of ossification and cartilage formation in embryological development. Ongoing growth in the posterior elements of the spine when there is a formation and/or segmentation failure in anterior structures of the spinal column may cause progressive segmental sharp kyphosis [12]. Other mechanisms, such as severe vertebral body and disc destruction in spinal tuberculosis can cause local, severe kyphotic deformity.…”

“…The literature indicates the development of paraplegia in advanced (late-stage) post-tuberculosis kyphotic deformity because of spinal cord compression [3456]. Paraplegia or paraparesis is uncommon in spinal deformities with underlying neurofibromatosis; however, SAK that accompanies existing spinal deformity may result in worsening of neurological deficits by either a compression or stretching effect on the spinal cord [7812]. Winter et al [9] have reported six paraparesis cases with normal history within 33 cases of SAK with underlying neurofibromatosis (range, 80°–180°) [12].…”

“…Paraplegia or paraparesis is uncommon in spinal deformities with underlying neurofibromatosis; however, SAK that accompanies existing spinal deformity may result in worsening of neurological deficits by either a compression or stretching effect on the spinal cord [7812]. Winter et al [9] have reported six paraparesis cases with normal history within 33 cases of SAK with underlying neurofibromatosis (range, 80°–180°) [12]. These data demonstrate that regardless of etiology, the incidence of developing neurological deficits is considerably high in untreated SAK cases [1011].…”

“…The development of neurological deficit risk in angular kyphosis patients may be related to age, etiology, congenital pathology type, involved level, and the severity of sharp local kyphosis. Accordingly, some of these defined radiographic criteria are detected in the sagittal views [1213]. However, the evaluation of anteroposterior radiographs is as important as the that of lateral radiographs.…”

Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis

“…Non-surgical interventions are not effective in decreasing the progression of kyphotic deformities [4]. Surgical intervention in early life is thought to be a cornerstone for these patients, because this will prevent deterioration of neurologic deficits and reduce the need for surgeries in late life when the spine becomes stiffer [1,5,6]. The wedged vertebra is mostly trapped in the thoracolumbar junction, difficult to access, with complex pathologic anatomy, closely related to the spinal cord, and in an area with abundant vascularity.…”