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PubMed2002

[Surgical treatment of idiopathic scoliosis and juvenile kyphosis].

Indication for operative treatment of idiopathic scoliosis and juvenile kyphosis is mainly cosmetic. There is also a higher incidence of pain in scoliosis patients, and reduced pulmonary function in severe deformity, especially in severe deformities present at the age of 5 years (early onset). Scoliotic curves of less than 30 degrees will not progress in adults, whereas curves of 50-75 degrees will further progress a mean of 25 degrees during 40 years. Progression in adults with juvenile kyphosis is not well documented. Operative treatment aims to stop progression, to control spinal growth, or to perform correction and fusion by spinal instrumentation and bone grafts. These goals can be achieved either by an anterior, a posterior, or a combined approach. Correction principles are compression, distraction, derotation and translation. The forces applied by correction are transferred by fixation devices (pedicle screws, anterior screws, hooks, sublaminar wires) to the spine. The higher correction forces are, the higher is the correction achieved, but also the risk of fracture and torn out implants. Mobilisation reduces rigidity and allows to achieve a better correction with equal forces. The best mobilisation techniques are disc excision, facet joint removal, and techniques to mobilise the thorax.

Adult↗
PubMedDate not supplied

Morphological analyses of paraspinal muscles: comparison of progressive lumbar kyphosis (camptocormia) and narrowing of lumbar canal by disc protrusions.

Progressive lumbar kyphosis (camptocormia), a rare, usually familial disease in elderly patients, is characterized by inability to immobilize the lumbar spine in relation to the pelvis. CT scan reveals selective involvement of the spinal muscles with a heterogeneous appearance and is in favour of a primary disorder of these muscles. Our aim was to define the muscular lesions and clarify their nature in this particular disorder. Biopsies of the paravertebral muscles of 14 patients with lumbar kyphosis and of 20 operated on for disc herniation or narrowed lumbar canal, were studied by light microscopy, histochemistry and electron microscopy. In both groups, type 1 fibre predominance and atrophy of type 2 fibres were observed. Ragged-red fibres with abnormal mitochondria also occurred. The differential feature was increased frequency of extensive diffuse or lobulated fibrosis in camptocormia. Other features related to pathogenesis could not be determined.

Adipose Tissue↗
PubMed2006

Esophageal transit of the weekly film-coated risedronate (Actonel) placebo tablet in subjects with Kyphosis.

Risedronate sodium is a pyridinyl bisphosphonate of proven effectiveness for the treatment and prevention of osteoporosis and Paget's disease of the bone. The aim of this study was to compare the esophageal transit and gastric emptying of the placebo film-coated risedronate tablet when taken with 50 or 120 mL of water in subjects with Kyphosis. A total of 23 patients with radiologically documented osteoporosis participated in a single-center, open-label, crossover gamma scintigraphy study. The mean esophageal transit times were 15.6 s (50 mL) and 12.0 s (120 mL) and the mean gastric emptying half-times were 20.5 min (50 mL) and 14.3 min (120 mL). There was no relationship between the degree of Kyphosis measured from lateral standing radiographs and the esophageal transit time. This study demonstrated that even when taken with a minimal volume of water the esophageal transit and gastric emptying of the film-coated 35 mg weekly risedronate placebo tablet was similar in kyphotic subjects to previously obtained results from healthy control subjects.

Administration, Oral↗
PubMed2005

Post-traumatic cervical kyphosis with surgical correction complicated by temporary anterior spinal artery syndrome.

Post-traumatic undiagnosed disco-ligamentous and osseous lesions of the cervical spine may eventually result in irreducible extreme kyphosis. Correction of such consolidated deformities requires major surgery with a combined posterior and anterior approach, aiming to correct bony impingement on neural and vascular structures, reduce deformity and to attain circumferential instrumentation and fusion in physiological alignment. This can be achieved using either a single-staged or a two-staged procedure. Regardless, this type of major surgery entails considerable neurological risks. Therefore, thorough planning of the intervention and considerable surgical experience is needed. We present an elderly woman with gross restriction of forward gaze and intractable nuchal and radicular pain due to cervical spine deformity. Her cervical kyphosis was corrected using preoperative skeletal axial traction for four days and subsequent operative reduction with circumferential instrumentation and fusion. The post-operative course was complicated by a temporary anterior spinal artery syndrome despite normal intraoperative somatosensory evoked potentials (SSEP) and by a wound infection requiring removal of the implant. Nevertheless, segmental fusion in physiological alignment was successfully achieved and the patient fully recovered from the neurological deficit and infection. Quality of life was significantly improved.

Accidental Falls↗
PubMed2006

Cervicothoracic kyphosis.

Cervicothoracic kyphotic deformity may inhibit horizontal gaze function, impede activities of daily living, and induce disabling pain. Eventually, some patients develop a chin-on-chest deformity that limits their ability to eat and drink; in the end stage, a few patients also may have difficulty breathing. Progressive kyphosis can stretch the spinal cord leading to myelopathy with progressive lower extremity spasticity and weakness. Indications for surgery include myelopathy, pain, dysphagia or dyspnea owing to kyphosis, and difficulty maintaining a functional horizontal gaze. Patients with unstable cervicothoracic fractures also require surgical fixation. For these patients, surgical goals include deformity correction with restoration of an acceptable forward gaze, re-establishment of sagittal balance, decompression of the spinal cord (if myelopathic), and stable fixation.

Cervical Vertebrae↗
PubMed2002

Cranial base kyphosis and the surface morphology of the anterior cranial fossa.

We investigated the relationship between the surface morphology of the anterior cranial fossa and cranial base kyphosis (sphenoid angle) in 52 cephalometric craniograms. Among them there were 25 female (mean age 54 +/- 15; range 31-82) and 27 male (mean age 43 +/- 18, range 19-85) skulls. The sphenoid angle and the altitudes of the highest elevation of the endofrontal eminence (cranial base over the orbital roof in the anterior cranial fossa) and the middle point of the sphenoid planum, measured according to the Frankfort horizontal, were analysed using classical cephalometric and morphometric analysis. Statistical analysis was performed by Pearson's product-moment correlation and simple linear regression. The sphenoid angle ranged from 97 degrees to 137 degrees (mean 118 +/- 9 degrees). The altitude ratio of the highest elevation of the endofrontal eminence and the middle point of the sphenoid planum ranged from 1.5 to 1.8 (mean 1.6 +/- 0.1). A significant correlation was found between this ratio and the sphenoid angle (r = -0.65; p < 0.001; coefficient of determination = 0.43). The elevation of the endofrontal eminence relative to the sphenoid planum was higher in skulls with increased cranial base kyphosis, whereas reduced sphenoid angle was associated with an increase in the elevations of the endofrontal eminence. Although the sphenoid angle has a significant effect on the morphology of the anterior cranial fossa, only 43% of the variance in altitude of the endofrontal eminence is likely to be explained by its relationship with the sphenoid angle.

Adult↗
PubMed1997

Vascularized fibula graft for spinal fusion in severe cervical kyphosis due to neurofibromatosis.

A successful anterior spinal fusion using vascularized fibula graft in the case of a 17-year-old male with severe cervical kyphosis due to neurofibromatosis is reported. Anterior spinal fusion at C2-7 using the fibula graft was performed with spinous process wiring. The kyphosis was corrected from 85 to 38 degrees. Bony fusion was obtained in 5 months without loss of correction.

Adolescent↗
PubMedDate not supplied

[Aortographic findings in children with myelomeningocele and lumbar kyphosis].

The findings in abdominal aortography performed preoperatively in 21 children with myelomeningocele (MMC), which underwent kyphectomy due to congenital kyphosis of the lumbar spine, are reported. In no case did the aorta follow the kyphotic radius of curvature. It rather seemed to be strung over the kyphosis like a tendon over a bow. An intraoperative lesion of the aorta seems rather unlikely, and this is why we believe, that a routinely performed preoperative abdominal aortography is not necessary. We found a remarkable number of anomalies of the intercostal and segmental arteries, which were only in part associated with deformities of the vertebral bodies. The kidneys seemed to be imbedded in the kyphotic concavity, partially with the inferior pole, partially in whole. In these cases the risk of intraoperative lesion seems higher. We found a number of cases with unilateral agenesis of the kidneys in the patients examined by us. Therefore we suggest the use of noninvasive methods prior to surgery in order to evaluate the presence of malpositions or malformations of the kidneys.

Abnormalities, Multiple↗
PubMedDate not supplied

[Straightening operations in juvenile kyphosis. Results in 31 cases using Harrington's dorsal compression spondylodesis or its combination with ventral osteodiskectomy and clip insertion].

Results of operative treatment in 31 cases of juvenile kyphosis are presented. In 23 cases a posterior Harrington spondylodesis, in 6 cases a combined staged anterior and posterior spondylodesis, in two cases an anterior spondylodesis alone were performed. The average preoperative angle in the first group was 50 degrees (15 degrees-83 degrees), the average postop, angle was 22 degrees representing an 56% average improvement of the initial angle. At reevaluation, however, an average loss of correction of 13.9 degrees or 49.6% reduction of the initial improvement was registered. The combined procedures started with an average preoperative angle of 60 degrees, the postsurgery value was 22 degrees representing 63% of improvement. In 6 cases the average loss of correction at reevaluation was only 7% or 18.9% of early improvement was lost. The results favor strongly a combined staged anterior and posterior procedure for correction. When the behaviour of the wedge vertebrae is included as well, this study offers clear indications for a differentiated treatment of choice in each case of severe juvenile kyphosis.

Adolescent↗
PubMed1976

The relationship of kyphosis to the shape of vertebral bodies.

An index which measures the wedge deformity of vertebral bodies in lateral chest radiographs in older people was calculated by dividing the sum of the vertical anterior heights of the lower six thoracic vertebral bodies and discs by the corresponding sum of vertical posterior heights. This index increased with increasing age in a similar manner in men and in women, in contradistinction to an index measuring kyphosis in which the age effect was greater in women. The index of wedging explained 42 per cent and 48 per cent of the variation in kyphosis in men and in women respectively. Additional effects due to age, detected in women only, added a further 4 per cent to the explained variation and may be due to ageing of soft tissues.

Aged↗
PubMed2006

Use of neurodevelopmental treatment techniques in a client with kyphosis: a case report.

This case report describes use of an intervention developed for patients with neurological diagnoses (neurodevelopmental treatment [NDT]) with a patient with musculoskeletal and pulmonary diagnoses. The patient was a 78-year-old woman referred to physical therapy for gait training, therapeutic exercises, and neuromuscular reeducation. Standing at her most upright, the patient initially had a 30 degrees kyphosis with extreme capital extension to bring her head to vertical. Shoulders were internally rotated, and the medial borders of the scapulae rested near the lateral border of the ribs and the scapular spines were at the level of C7. To address the postural impairments, I used NDT spinal and scapular mobilization techniques and strengthening in weight-bearing postures with modified bridging as preparation for gait training. At the end of the episode of care, the patient's upright posture had improved to 10 degrees kyphosis with head in neutral extension in both standing and walking.

Aged↗
PubMed2003

Scheuermann's kyphosis following cervical spinal cord injury.

BACKGROUND: Scheuermann's kyphosis is an uncommon autosomal dominant disease that manifests as a progressive thoracic skeletal deformity. It can lead to severe restrictive lung disease or predispose to spinal cord injury (SCI). Neurologic sequelae are rarely reported in the literature. METHOD: Case Presentation SUMMARY: A 47-year-old man sustained a cervical SCI requiring surgical anterior fusion and reoperation for fracture of the affected vertebra. One year after SCI, he presented with further kyphotic progression and cervical spine instability. Clinical presentation and family history led to a diagnosis of Scheuermann's kyphosis. To prevent further progression, he underwent extensive multilevel anterior and posterior surgical stabilization. CONCLUSION: This case illustrates the importance of early diagnosis and treatment of progressive spinal deformities. With proper surgical correction, this patient made substantial gains in mobility, self-care, and respiratory status.

Humans↗
PubMedDate not supplied

Scheuermann's kyphosis--long-term results of Milwaukee braces treatment.

A review of 203 patients with Scheuermann's kyphosis is presented. The modified Milwaukee brace was used in 62 patients. Thirty-nine patients wore the brace for an average of 18 months. The pretreatment kyphosis averaged 62 degrees, and the curve at the completion of brace treatment averaged 41 degrees. Follow-up of more than 18 months after brace wear showed an average 15 degrees loss of correction. Wedging of the vertebral bodies improved from 7.9 degrees to 6.8 degrees with brace treatment. To provide permanent correction, vertebral wedging must improve to approximately 5 degrees. Most patients will require full-time brace wear of longer than 18 months to effect this improvement in vertebral wedging. The brace can improve kyphotic curves greater than 75 degrees.

Adolescent↗
PubMedDate not supplied

Combined anterior and posterior fusion for Scheuermann's kyphosis.

Combine anterior and posterior fusion provides and maintains good correction in patients with Scheuermann's kyphosis. A fusion which includes the entire deformity, especially at lower end, is a requisite for a satisfactory result. Intervening halofemoral traction may not improve results. Pulmonary functions may decrease somewhat postoperatively but, in the large majority of cases, still remain within normal limits. We think that anterior and posterior fusion remains the procedure of choice in severe or rigid Scheuermann's kyphosis.

Adolescent↗
PubMedDate not supplied

Congenital kyphosis.

Thirty-four consecutive patients with congenital kyphosis treated surgically between 1971 and 1979 at Boston Children's Hospital were reviewed. Cases were classified into 25 Type I (failure of formation), seven Type II (failure of anterior segmentation), and two Type III (mixed). Staged anterior decompression and posterior fusion was the treatment in 15 Type I cases. Five Type II cases underwent posterior fusion. Patients ambulated in a body cast postoperatively for six months. Neurologic deficit improved postoperatively in six of eight cases. Pseudarthrosis occurred in two of 27 cases (7%) followed for one year. Early surgical treatment of Type I deformity is recommended. Anterior decompression is essential with neurologic deficit. Anterior and posterior fusion are recommended when kyphosis is greater than 60 degrees.

Adolescent↗
PubMedDate not supplied

Vertebral body replacement with femoral neck allograft and vascularized rib strut graft. A technique for treating post-traumatic kyphosis with neurologic deficit.

A technique using a vascularized rib pedicle graft and femoral neck allograft is presented as a new method of anterior spine fusion in the treatment of symptomatic post-traumatic kyphosis. The cases of six patients are reviewed who were treated surgically from seven months to 24 years following their initial injury. Substantial neurologic improvement was achieved in four patients with incomplete neurologic deficits when the procedure was combined with an anterior spine decompression. Two patients, one who was neurologically normal and one with complete paraplegia and L-1 pseudarthrosis were relieved of chronic back and radicular pain following this procedure. At the time of followup, complete anterior spine decompression was verified by lateral planography or computerized axial tomography. All patients were found to have solid anterior spine fusions with a 63% mean improvement in preoperative kyphosis. Early and rapid incorporation of bone grafts had been demonstrated, thus requiring shorter external immobilization periods for the patients.

Adolescent↗
PubMedDate not supplied

Surgical management of severe thoracic lordosis. A new technique to restore normal kyphosis.

A technique of combined anterior and posterior surgery for correction of severe thoracic lordosis with the restoration of normal kyphosis is described. The results in three patients are presented. Preliminary results suggest that this is a valid procedure for obtaining a normal thoracic kyphosis, and that correction of thoracic lordosis may result in improved pulmonary function.

Adolescent↗
PubMedDate not supplied

The incidence of Klippel-Feil syndrome in patients with congenital scoliosis and kyphosis.

A retrospective review of the radiographs of 1215 patients with congenital scoliosis and kyphosis disclosed 298 (25%) to have segmentation defects in the cervical spine. A single level defect was seen in 82 patients, 52 of which were at C2-C3. Of the 298 patients, 235 had scoliosis, (6 cervical, 42 cervicothoracic, 75 thoracic, 4 thoracolumbar, and 1 lumbar), 36 had kyphoscoliosis, 10 lordoscoliosis, and 17 pure kyphosis.

Child↗