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Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation.
Spine (Phila Pa 1976). 2008 May 15; 33(11):1229-35.S

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To evaluate the outcomes of anterior decompression and fusion followed by posterior instrumented fusion using pedicle screws without intentional correction of severe angular kyphosis deformity with myelopathy.

SUMMARY OF BACKGROUND DATA

Treatment of severe angular kyphosis with myelopathy is extremely difficult and dangerous. Although surgical circumferential spinal osteotomy via a single posterior approach has been reported in several studies, serious neurologic complications are a possible outcome.

MATERIALS AND METHODS

Among 51 patients surgically treated for angular kyphosis from 1988 to 2004, 16 patients (follow-up period, 32-168 months; mean, 72 months) with severe (>70 degrees) angular kyphosis with progressive myelopathic symptoms underwent anterior decompression and fusion, followed by posterior pedicle screw instrumentation and bone graft without attempted correction of the deformity. Radiologic assessment, clinical findings including pain and daily activity scores, and neurologic status using the modified Frankel grade were analyzed before surgery and at the last follow-up.

RESULTS

Curve progression or nonunion did not occur in any of the cases. The mean pain and daily activity score were 3.1 and 2.3 before surgery and 4.7 and 4.2 after surgery, respectively. The modified Frankel grade indicated that every patient but one had improved neurologic function by one or more grades. Nine (75%) of 12 patients with ankle clonus, 10 (71%) of 14 patients with Babinski sign, and 6 (55%) of 11 patients with bowel and bladder dysfunction showed full improvement at the last follow-up. Postoperative complications included 1 screw pullout case and 2 infection cases which resolved without incidence.

CONCLUSION

Anterior decompression and fusion followed by posterior pedicle screw instrumentation and fusion without correction effectively improved neurologic symptoms and halted progression of kyphotic deformity in cases of severe angular kyphosis with myelopathy.

Authors+Show Affiliations

Department of Orthopedic Surgery, Chung-Ang University, Seoul, Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18469697

Citation

Song, Kwang-Sup, et al. "Surgical Treatment of Severe Angular Kyphosis With Myelopathy: Anterior and Posterior Approach With Pedicle Screw Instrumentation." Spine, vol. 33, no. 11, 2008, pp. 1229-35.
Song KS, Chang BS, Yeom JS, et al. Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation. Spine. 2008;33(11):1229-35.
Song, K. S., Chang, B. S., Yeom, J. S., Lee, J. H., Park, K. W., & Lee, C. K. (2008). Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation. Spine, 33(11), 1229-35. https://doi.org/10.1097/BRS.0b013e31817152b3
Song KS, et al. Surgical Treatment of Severe Angular Kyphosis With Myelopathy: Anterior and Posterior Approach With Pedicle Screw Instrumentation. Spine. 2008 May 15;33(11):1229-35. PubMed PMID: 18469697.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation. AU - Song,Kwang-Sup, AU - Chang,Bong-Soon, AU - Yeom,Jin Sup, AU - Lee,Jae Hyup, AU - Park,Kun-Woo, AU - Lee,Choon-Ki, PY - 2008/5/13/pubmed PY - 2008/9/25/medline PY - 2008/5/13/entrez SP - 1229 EP - 35 JF - Spine JO - Spine VL - 33 IS - 11 N2 - STUDY DESIGN: Retrospective study. OBJECTIVE: To evaluate the outcomes of anterior decompression and fusion followed by posterior instrumented fusion using pedicle screws without intentional correction of severe angular kyphosis deformity with myelopathy. SUMMARY OF BACKGROUND DATA: Treatment of severe angular kyphosis with myelopathy is extremely difficult and dangerous. Although surgical circumferential spinal osteotomy via a single posterior approach has been reported in several studies, serious neurologic complications are a possible outcome. MATERIALS AND METHODS: Among 51 patients surgically treated for angular kyphosis from 1988 to 2004, 16 patients (follow-up period, 32-168 months; mean, 72 months) with severe (>70 degrees) angular kyphosis with progressive myelopathic symptoms underwent anterior decompression and fusion, followed by posterior pedicle screw instrumentation and bone graft without attempted correction of the deformity. Radiologic assessment, clinical findings including pain and daily activity scores, and neurologic status using the modified Frankel grade were analyzed before surgery and at the last follow-up. RESULTS: Curve progression or nonunion did not occur in any of the cases. The mean pain and daily activity score were 3.1 and 2.3 before surgery and 4.7 and 4.2 after surgery, respectively. The modified Frankel grade indicated that every patient but one had improved neurologic function by one or more grades. Nine (75%) of 12 patients with ankle clonus, 10 (71%) of 14 patients with Babinski sign, and 6 (55%) of 11 patients with bowel and bladder dysfunction showed full improvement at the last follow-up. Postoperative complications included 1 screw pullout case and 2 infection cases which resolved without incidence. CONCLUSION: Anterior decompression and fusion followed by posterior pedicle screw instrumentation and fusion without correction effectively improved neurologic symptoms and halted progression of kyphotic deformity in cases of severe angular kyphosis with myelopathy. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/18469697/Surgical_treatment_of_severe_angular_kyphosis_with_myelopathy:_anterior_and_posterior_approach_with_pedicle_screw_instrumentation_ L2 - http://dx.doi.org/10.1097/BRS.0b013e31817152b3 DB - PRIME DP - Unbound Medicine ER -