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The surgical management of congenital kyphosis and kyphoscoliosis.
Spine (Phila Pa 1976). 2001 Oct 01; 26(19):2146-54; discussion 2155.S

Abstract

STUDY DESIGN

A retrospective study of surgery for congenital kyphosis and kyphoscoliosis.

OBJECTIVE

To assess the effectiveness of different types of spine surgery in the management of congenital kyphosis and kyphoscoliosis.

SUMMARY OF BACKGROUND DATA

Congenital kyphosis and kyphoscoliosis are much less common than congenital scoliosis but potentially more serious, because these curves can progress rapidly and Type I deformities can lead to spinal cord compression and paraplegia. No one operative procedure can be applied to all types and sizes of deformity. The method of surgical treatment depends on the age of the patient, the type and size of the deformity, and the presence or absence of spinal cord compression causing a neurologic deficit.

METHODS

Sixty-five patients with a congenital kyphosis (n = 14) or kyphoscoliosis (n = 51) were treated by five different methods of spine arthrodesis: prophylactic posterior arthrodesis before age of 5 years (n = 11), posterior arthrodesis after age 5 years without instrumentation (n = 26) and with instrumentation (n = 12), combined anterior and posterior arthrodesis without instrumentation (n = 7) and with instrumentation (n = 9). Six patients had preoperative lower limb spastic paraparesis caused by spinal cord compression. The mean age at surgery was 9 years 6 months (range, 11 months to 25 years), and all 65 patients were observed for a minimum of 2 years (mean 6 years 6 months, range 2 to 18 years). Fifty-seven patients reached skeletal maturity.

RESULTS

A posterior arthrodesis performed before the age of 5 years resulted in a gradual reduction of the kyphosis by a mean 15 degrees in 9 of the 11 patients, followed up for a mean of 11 years, whose initial kyphosis was less than 55 degrees. Patients treated after the age of 5 years by a posterior arthrodesis followed by cast application had poor correction and a high incidence of pseudarthrosis. This was not significantly improved by the addition of posterior instrumentation. For curves greater than 60 degrees, the most successful results were achieved by an anterior spinal release and arthrodesis with strut graft correction followed by posterior arthrodesis with instrumentation (if possible).

CONCLUSION

All patients with a Type I or Type III congenital kyphosis or kyphoscoliosis should be treated by a posterior arthrodesis before the age of 5 years and before the kyphosis exceeds 50 degrees. A kyphosis that does not reduce to less than 50 degrees as measured on the lateral spine radiograph made with the patient supine requires an anterior release and arthrodesis with strut grafting followed by posterior arthrodesis with instrumentation (if possible).

Authors+Show Affiliations

Edinburgh Spine Deformity Centre, Princess Margaret Rose Orthopaedic Hospital, Edinburgh, UK. mmm@connectfree.co.ukNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11698894

Citation

McMaster, M J., and H Singh. "The Surgical Management of Congenital Kyphosis and Kyphoscoliosis." Spine, vol. 26, no. 19, 2001, pp. 2146-54; discussion 2155.
McMaster MJ, Singh H. The surgical management of congenital kyphosis and kyphoscoliosis. Spine. 2001;26(19):2146-54; discussion 2155.
McMaster, M. J., & Singh, H. (2001). The surgical management of congenital kyphosis and kyphoscoliosis. Spine, 26(19), 2146-54; discussion 2155.
McMaster MJ, Singh H. The Surgical Management of Congenital Kyphosis and Kyphoscoliosis. Spine. 2001 Oct 1;26(19):2146-54; discussion 2155. PubMed PMID: 11698894.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The surgical management of congenital kyphosis and kyphoscoliosis. AU - McMaster,M J, AU - Singh,H, PY - 2001/11/8/pubmed PY - 2002/1/16/medline PY - 2001/11/8/entrez SP - 2146-54; discussion 2155 JF - Spine JO - Spine VL - 26 IS - 19 N2 - STUDY DESIGN: A retrospective study of surgery for congenital kyphosis and kyphoscoliosis. OBJECTIVE: To assess the effectiveness of different types of spine surgery in the management of congenital kyphosis and kyphoscoliosis. SUMMARY OF BACKGROUND DATA: Congenital kyphosis and kyphoscoliosis are much less common than congenital scoliosis but potentially more serious, because these curves can progress rapidly and Type I deformities can lead to spinal cord compression and paraplegia. No one operative procedure can be applied to all types and sizes of deformity. The method of surgical treatment depends on the age of the patient, the type and size of the deformity, and the presence or absence of spinal cord compression causing a neurologic deficit. METHODS: Sixty-five patients with a congenital kyphosis (n = 14) or kyphoscoliosis (n = 51) were treated by five different methods of spine arthrodesis: prophylactic posterior arthrodesis before age of 5 years (n = 11), posterior arthrodesis after age 5 years without instrumentation (n = 26) and with instrumentation (n = 12), combined anterior and posterior arthrodesis without instrumentation (n = 7) and with instrumentation (n = 9). Six patients had preoperative lower limb spastic paraparesis caused by spinal cord compression. The mean age at surgery was 9 years 6 months (range, 11 months to 25 years), and all 65 patients were observed for a minimum of 2 years (mean 6 years 6 months, range 2 to 18 years). Fifty-seven patients reached skeletal maturity. RESULTS: A posterior arthrodesis performed before the age of 5 years resulted in a gradual reduction of the kyphosis by a mean 15 degrees in 9 of the 11 patients, followed up for a mean of 11 years, whose initial kyphosis was less than 55 degrees. Patients treated after the age of 5 years by a posterior arthrodesis followed by cast application had poor correction and a high incidence of pseudarthrosis. This was not significantly improved by the addition of posterior instrumentation. For curves greater than 60 degrees, the most successful results were achieved by an anterior spinal release and arthrodesis with strut graft correction followed by posterior arthrodesis with instrumentation (if possible). CONCLUSION: All patients with a Type I or Type III congenital kyphosis or kyphoscoliosis should be treated by a posterior arthrodesis before the age of 5 years and before the kyphosis exceeds 50 degrees. A kyphosis that does not reduce to less than 50 degrees as measured on the lateral spine radiograph made with the patient supine requires an anterior release and arthrodesis with strut grafting followed by posterior arthrodesis with instrumentation (if possible). SN - 0362-2436 UR - https://www.unboundmedicine.com/medline/citation/11698894/The_surgical_management_of_congenital_kyphosis_and_kyphoscoliosis_ L2 - http://dx.doi.org/10.1097/00007632-200110010-00021 DB - PRIME DP - Unbound Medicine ER -