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PubMed1984

Severe postlaminectomy kyphosis treatment by total vertebrectomy (plus late recurrence of childhood spinal cord astrocytoma).

A case of recurrent spinal astrocytoma is presented 25 years following initial biopsy and radiation therapy. Extensive laminectomy was performed when the patient was 20 months old. Three years later the patient became paraplegic as the result of progressive severe kyphosis. Late recurrence of tumor was marked by pain onset. In addition to treating the tumor, extensive spinal reconstruction was required to control the kyphosis.

Adult↗
PubMedDate not supplied

Management of myelomeningocele kyphosis in the older child by kyphectomy and segmental spinal instrumentation.

Kyphosis in the myelomeningocele patient population causes significant problems such as skin breakdown, recurrent infection, and decreased function. Kyphectomy has proved to be a satisfactory means of correcting the deformity, but postoperative stabilization to prevent recurrence of deformity continues to be a problem. Twelve patients with myelomeningocele kyphosis, measuring an average of 124 degrees, were managed by posterior kyphectomy and segmental spinal instrumentation. After operation, the curves measured an average of 32.8 degrees. With a follow-up period, 6-57 months, only one patient lost correction. The loss of correction was secondary to rod failure. Straight midline incision, ignoring previous incisions, can be used to approach the spine without risk of increased wound complications. Adequate immediate stable correction can be achieved by kyphectomy and segmental spinal instrumentation with anterior fixation to the pelvis that thus allows the patient to proceed more quickly to an improved functional level.

Adolescent↗
PubMed1987

Relationship between kyphosis, scoliosis, and osteoporosis in the elderly population.

In 56 valid subjects 60 years old or more, bone mineral content (BMC) of the second, third, and fourth lumbar vertebrae and of femoral neck was measured by dual-photon absorptiometry. Dorsal kyphosis and lumbar and dorso-lumbar scoliosis were determined from radiographs using the Cobb methods. Kyphosis was positively correlated with low BMC but not with scoliosis. Scoliosis was positively correlated with femoral neck BMC but not with vertebral BMC.

Aged↗
PubMed1988

Treatment of cervical kyphosis in children.

Children with severe cervical kyphosis present a difficult treatment challenge. The most common etiology of this deformity is extensive laminectomies, especially associated with postlaminectomy irradiation. The deformity can be rapidly progressive leading to neurologic involvement. With intact posterior elements, kyphosis can occur as a result of congenital, traumatic, metabolic or neoplastic processes. Treatment is directed towards early recognition, arrest of the progression of deformity, and improvement of neurologic symptoms. Patients with loss of posterior elements can be treated effectively by preoperative traction and a single-staged anterior release with strut fusion. Patients with intact posterior elements require preoperative traction, initial posterior osteotomies with intraoperative traction, then an anterior release with strut fusion. All patients need rigid postoperative halo immobilization for a minimum of 3 to 4 months to maintain position. Using these techniques, nine patients were treated surgically with satisfactory outcomes.

Adolescent↗
PubMed1991

Vertebral alterations in Scheuermann's kyphosis.

In a cadaver-derived skeletal collection of 1,384 thoracolumbar spinal columns, 103 (7.4%) individuals with vertebral changes of Scheuermann's kyphosis were identified. Anterior extension of the vertebral specimens was noted in 94% of affected specimens. No evidence of osteoporosis was noted by single-photon absorptiometric analysis in the affected sample compared with a normal control group. Biopsy specimens from two immature patients obtained at surgery suggested disorganized endochondral ossification similar to that noted in Blount's disease. It was concluded that increased pressure on the anterior margin of the centrum is responsible for histologic and morphologic changes of Scheurermann's kyphosis.

Absorptiometry, Photon↗
PubMed1991

Lumbosacral kyphosis, tethered cord, and diplomyelia. A unique spinal dysraphic condition.

Four patients are described with a triad of neuroectodermal abnormalities consisting of lumbosacral kyphosis, tethered cord, and dyplomyelia. Of utmost importance is the recognition of the association between this type of kyphosis and the underlying spinal cord pathology and the progressive nature of the deformity. The patient presenting with lumbosacral kyphos and the presence of sacral hypoplasia should have a neuroradiographic evaluation (magnetic resonance imaging scanning or enhanced computed tomography) to rule out the presence of a tethered cord or other neural abnormalities. Early surgical intervention for release of the tether and fusion should be carried out to prevent neurologic deterioration and curve progression.

Diagnostic Imaging↗
PubMed1993

Cervical congenital kyphosis with atlantoaxial dislocation. A case report.

Congenital kyphosis and atlantoaxial dislocation in a 13-year-old boy was treated by a C1 laminectomy and C2-C5 laminoplasty with fusion from the occiput to C2. This resulted in postoperative neurologic deterioration, but a secondary anterior C3 vertebrectomy followed by a C2-C5 fusion helped restore neural function. In the presence of congenital cervical kyphosis, anterior rather than posterior decompression and fusion is recommended, particularly in the presence of a stenotic spinal canal.

Adolescent↗
PubMed1993

Thoracic kyphosis associated with a thymic cyst.

Cystic masses of the thymus are usually asymptomatic. Any symptoms are usually related to fluid accumulation and the cyst's accompanying increase in size. The authors report a case presenting with kyphosis and late recognition of the associated thymic cyst. We found no reports in the literature of a thymic cyst preceded by or associated with kyphosis and the mechanisms of this association are unknown.

Adolescent↗
PubMed1994

A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis.

STUDY DESIGN: The authors employed a new mode of treatment for spinal tuberculosis consisting of single stage posterior instrumentation and fusion without anterior debridement. Ten patients were operated upon in this manner. Chemotherapy was instituted 2 weeks preoperatively and continued for a mean period of 11 months. Cotrel-Dubousset or a comparable system was used for fixation. OBJECTIVES: Patients were followed for 3 monthly intervals with serial anteroposterior and lateral x-rays, erythrocyte sedimentation rate, physical examination, and patients' self reports. The mean follow up period was 24.2 months (range, 17-36 months). METHODS: Measurement of kyphosis angle in the lateral x-ray view was used to evaluate treatment. RESULTS: Only a 3.4 degrees mean loss of correction was observed over the follow-up period. All patients were satisfied. CONCLUSION: Our results show that posterior rigid fixation and chemotherapy provide satisfactory stabilization, reduce surgical morbidity, and prevent development of late kyphosis in selected patients with Pott's disease of the thoracolumbar spine.

Antitubercular Agents↗
PubMed1996

Cervical kyphosis after resolution of myopathic head drop. A case report.

STUDY DESIGN: This is a case report. OBJECTIVES: To present a case of cervical kyphosis after resolution of myopathic head drop. SUMMARY OF BACKGROUND DATA: Myopathic head drop is a severe and persistent local myopathy that never progresses beyond the neck extensor muscles. METHODS: A case is reported of a hospitalized psychiatric patient who experienced the sudden onset of severe neck extensor weakness consistent with myopathic head drop. RESULTS: Although myopathic head drop resolved after 2 years, it left a disabling residual skeletal deformity of the cervical spine. CONCLUSIONS: Myopathic head drop may be a cause of cervical kyphosis.

Adaptation, Physiological↗
PubMed2001

Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability.

STUDY DESIGN: Statistical analysis of various measurement techniques for thoracolumbar burst fracture kyphosis on lateral radiograph. OBJECTIVE: To determine the most reliable measurement technique. SUMMARY OF BACKGROUND DATA: The treatment of thoracic and lumbar burst fractures involves many factors, including the degree of resultant kyphosis. Although various methods have been described, no study has directly compared these methods for reliability and reproducibility. METHODS: Fifty lateral radiographs of thoracic and lumbar burst fractures were randomly selected and measured on two separate occasions by three spine surgeons using five different measurement techniques. Radiograph quality, fracture type, and the center beam location were determined. Statistical analysis included analysis of variance for repeated measures and analysis of variance using a generalized linear model. RESULTS: Intraclass correlation coefficients were most consistent for Method 1 (rho = 0.83-0.94) followed by Method 4 (rho = 0.65-0.89) and Method 5 (rho = 0.73-0. 85). Intraobserver agreement (% of repeated measures within 5 degrees of the original measurement) ranged between 72% and 98% for all techniques for all three observers, with Method 1 showing the best agreement (84%-98%). Paired comparisons between observers varied considerably with interobserver reliability correlation coefficients ranging from 0.52 to 0.93. Method 1 showed the highest interobserver reliability coefficient (0.81, range 0.71-0.93) followed by Method 5 (0.71, range 0.68-0.75). Method 1 also had the highest percentage of agreement within categories (90% within 5 degrees ). CONCLUSIONS: Method 1 (measuring from the superior endplate of the vertebral body one level above the injured vertebral body to the inferior endplate of the vertebral body one level below) showed the best intraobserver and interobserver reliability overall.

Analysis of Variance↗
PubMed2002

Does instrumented anterior scoliosis surgery lead to kyphosis, pseudarthrosis, or inadequate correction in adults?

STUDY DESIGN: Retrospective review of cases in which a single solid rod was used for the anterior correction of thoracolumbar and lumbar idiopathic scoliosis in adults. OBJECTIVES: To evaluate the efficacy and outcomes in these patients. SUMMARY OF BACKGROUND DATA: Anterior spinal fusion with instrumentation has been found to be kyphogenic in the treatment of scoliosis. Recent reports have shown an extremely high rate of pseudarthrosis and implant failure even in adolescents who have undergone anterior spinal fusion with a single flexible or rigid rod. METHODS: Fifteen consecutive adult patients with (average age, 37.5 years) had undergone anterior spinal fusion with a rigid rod were included in this study. One was lost to follow-up, leaving 14 patients with a complete radiographic follow-up of 44 months and clinical follow-up of 61 months. Patients were sent the Modified Scoliosis Research Society (SRS) Outcomes Instrument, charts were reviewed, and preoperative, postoperative, and final follow-up films of the entire spine were evaluated by independent reviewers uninvolved in the care of the patients. RESULTS: The average preoperative major curve was 50 degrees, which improved to 16 degrees at follow-up (a 66% correction). The average correction of the upper compensatory curve and lower fractional curve were 40% and 61%, respectively. The thoracolumbar sagittal plane alignment was maintained or improved in all patients (i.e., this surgery did not induce kyphosis in any patient). On average 0.9 levels were "saved" compared with levels chosen by the authors for posterior surgery. All patients achieved a solid fusion. Follow-up Modified SRS questionnaires revealed a satisfaction score 4.5 out of a possible score of 5, a pain score of 4.1 out of 5, a self-image score of 4.1 out of 5, a function score of 4.1 out of 5, and a mental health score of 4.0 out of 5, with an overall score of 82%. All patients but one were satisfied or extremely satisfied with the results of surgery. There was no incidence of implant breakage. CONCLUSIONS: The results of anterior spinal fusion using a single solid rod in adults with idiopathic scoliosis in this series are excellent, with 100% fusion rate, no development of kyphosis, and no incidence of hardware failure.

Adult↗
PubMed2005

Surgical management of severe cervical kyphosis with myelopathy in osteogenesis imperfecta: a case report.

STUDY DESIGN: A case of a 9-year-old child with Osteogenesis Imperfecta and severe cervical kyphosis associated with wedged vertebrae and progressive neurological deterioration is presented. OBJECTIVE: To highlight the difficulties in surgical management of this condition and to discuss the appropriate surgical approach. SUMMARY OF BACKGROUND DATA: This case demonstrates an unusual case of Osteogenesis Imperfecta with associated wedged vertebrae causing a quadriparesis. Surgical decompression and stabilization can be performed with resolution of symptoms even in this age group with the appropriate approach and implants. METHODS: A 9-year-old girl presented with progressive cervical kyphosis and quadriparesis. At the age of 3 years, she underwent posterior cervical fusion (C1-C6) for instability. Radiological and laboratory investigations confirmed the diagnosis of Osteogenesis Imperfecta, and radiographs of the cervical spine revealed a kyphotic deformity of 120 degrees . Magnetic resonance imaging and computerized tomography scans showed anterior cord compression attributable to wedged vertebrae at C3 and C4. Magnetic resonance imaging-angiography was performed before surgery to identify the anatomic position of the vertebral arteries. A modified anterolateral approach to the upper cervical spine was performed, and anterior C3 and C4 corpectomies with interbody cage and plate fixation were carried out. RESULTS: After surgery the patient made a full neurological recovery, and significant correction of the deformity was achieved and maintained at follow-up. CONCLUSIONS: Cervical kyphotic deformity in Osteogenesis Imperfecta is uncommon. Association of this condition with wedged vertebrae is rare. Surgical decompression of the upper cervical spine is a challenging problem in the presence of this deformity. Which surgical approach to use is controversial. There are difficulties exposing wedged vertebrae by a standard anterior approach, and hence we have used a modified anterolateral approach to address this surgical problem, because a posterolateral approach was impossible with the intervening vertebral arteries. Spinal stabilization in children with Osteogenesis Imperfecta and poor bone stock is a challenge. We have used a small diameter MOSS cage ("Harms mesh cage") with maxillofacial plate and screws to achieve stabilization and fusion.

Bone Plates↗
PubMed2005

Measurement of fracture kyphosis with the Oxford Cobbometer: intra- and interobserver reliabilities and comparison with other techniques.

STUDY DESIGN: Statistical analysis of 3 techniques for measuring thoracolumbar kyphosis secondary to fracture. OBJECTIVES: To determine the reliability of using an Oxford Cobbometer and assess the most reliable measurement technique. SUMMARY OF BACKGROUND DATA: The reproducibility of Cobb angles for the assessment of saggital plane deformity on spine radiographs has been shown to have significant variability in both intra- and interobserver error. METHODS: Twenty-four lateral spine radiographs of patients with thoracic and lumbar vertebral fractures were measured on 2 separate occasions, in random order, by 4 blinded observers using the same Oxford Cobbometer and ruler. RESULTS: Method 2, the angle from the inferior endplate of the vertebra above the fractured vertebra to the superior endplate of the vertebra below the fractured vertebra, had the greatest intraobserver and interobserver reliabilities (rho = 0.856-0.976 and rho = 0.95, respectively). The other 2 methods had lower reliabilities; however, all 3 methods were well above the statistically acceptable threshold of >0.8, and the intraobserver reliabilities with each observer was 99% overall. These reliabilities supersede results reported previously using the conventional Cobb technique. The absolute mean difference between readings and 95% limit of agreement also improves on previous data, 2 degrees and +/- 5.8 degrees , respectively. CONCLUSIONS: Highest intraclass correlation coefficients were obtained using method 2. Using the Oxford Cobbometer to measure fracture kyphosis has higher reliability than the standard Cobb angle technique. It is easy and quick to use in a clinical setting.

Diagnostic Techniques and Procedures↗
PubMed2005

Proximal junctional kyphosis in adult spinal deformity following long instrumented posterior spinal fusion: incidence, outcomes, and risk factor analysis.

STUDY DESIGN: To analyze patient outcomes and risk factors associated with proximal junctional kyphosis (PJK) in adults undergoing long posterior spinal fusion. OBJECTIVES: To determine the incidence of PJK and its effect on patient outcomes and to identify any risk factors associated with developing PJK. SUMMARY OF BACKGROUND DATA: The incidence of PJK and its affect on outcomes in adult deformity patients is unknown. No study has concentrated on outcomes of patients with PJK. Risk factors for developing PJK are unknown. METHODS: Radiographic data on 81 consecutive adult deformity patients with minimum 2-year follow-up (average 5.3 years, range 2-16 years) treated with long instrumented segmental posterior spinal fusion was collected. Preoperative diagnosis was adult scoliosis, sagittal imbalance or both. Radiographic measurements analyzed included the sagittal Cobb angle at the proximal junction on preoperative, early postoperative, and final follow-up standing long cassette radiographs. Additional measurements used for analysis included the C7-Sacrum sagittal plumb and the T5-T12 sagittal Cobb. Postoperative SRS-24 scores were available on 73 patients. RESULTS: Incidence of PJK as defined was 26%. Patients with PJK did not have lower outcomes scores. PJK did not produce a more positive sagittal C7 plumb. PJK was more common at T3 in the upper thoracic spine. CONCLUSIONS: Incidence of proximal junctional kyphosis was high, but SRS-24 scores were not significantly affected in patients with PJK. The sagittal C7 plumb was not significantly more positive in PJK patients. No patient, radiographic, or instrumentation variables were identified as risk factors for developing PJK.

Adult↗
PubMed2005

Proximal junctional kyphosis in adolescent idiopathic scoliosis following segmental posterior spinal instrumentation and fusion: minimum 5-year follow-up.

STUDY DESIGN: A retrospective study. OBJECTIVE: To analyze the long-term proximal junctional change in adolescent idiopathic scoliosis (AIS) following segmental posterior spinal instrumentation and fusion 5 years or more after surgery. SUMMARY OF BACKGROUND DATA: No study has concentrated on time-dependent long-term proximal junctional change in AIS following segmental posterior spinal instrumentation and fusion after 5 years postoperation. Risk factors for developing proximal junctional kyphosis (PJK) are unknown. METHODS: A total of 193 consecutive AIS patients with a minimum 5-year follow-up (average, 7.3 years; range, 5-16.7 years) treated with segmental posterior spinal instrumentation and fusion were evaluated. Radiographic measurements analyzed included sagittal Cobb angle at the proximal junction on preoperative, early postoperation, 2-year postoperation, and final follow-up (> or = 5 years) by standing long cassette radiographs. Postoperative Scoliosis Research Society (SRS)-24 outcome scores were also evaluated. Abnormal PJK was defined as the final proximal junctional sagittal Cobb angle between the lower endplate of the uppermost instrumented vertebra and the upper endplate of two vertebrae supra-adjacent, which was > 10 degrees and at least 10 degrees greater than the preoperative measurement. RESULTS: The incidence of PJK at 7.3 years postoperation was 26% (50 of 193 patients). The average proximal junctional angle increased 15.2 degrees until 2 years postoperation and then increased 1.7 degrees until final follow-up in the PJK group (n = 50). Factors that were statistically significant for PJK development were as follows: a thoracoplasty procedure (P = 0.001), preoperative hyperkyphotic thoracic alignment (T5-T12 > 40 degrees) (P = 0.015), and hybrid instrumentation (proximal hooks and distal pedicle screws) compared with the hooks only group (P = 0.029). The number of fused vertebrae more than 11 was also related with PJK (P = 0.08). The level of the uppermost instrumented vertebra did not affect the PJK incidence. SRS-24 outcome scores did not demonstrate any significant differences (P = 0.54 for total score and P = 0.49 for self-image subscale) between the PJK and non-PJK groups. CONCLUSION: The incidence of proximal junctional kyphosis at 7.3 years postoperation was 26% and did not progress significantly after 2 years postoperation. Risk factors for developing PJK were an associated thoracoplasty, hybrid instrumentation (proximal hooks and distal pedicle screws), and a preoperative larger sagittal thoracic Cobb angle (T5-T12 > 40 degrees). The SRS-24 outcome instrument was not affected by PJK.

Adolescent↗
PubMed2006

Postlaminectomy kyphosis in the skeletally immature achondroplast.

STUDY DESIGN: Retrospective review. OBJECTIVES: To determine the risk of postlaminectomy thoracolumbar kyphosis in skeletally immature achondroplasts and evaluate the need for concurrent fusion at multilevel decompression. SUMMARY OF BACKGROUND DATA: Spinal stenosis is a relatively common complication of achondroplasia. Although most achondroplasts do not develop symptomatic spinal stenosis until the third or fourth decades, some patients become symptomatic before skeletal maturity. While postlaminectomy kyphosis typically does not occur in the adult achondroplast, it is not known if it occurs in the skeletally immature achondroplast. METHODS: The charts and radiographs of 10 consecutive skeletally immature achondroplasts that underwent surgical treatment for symptomatic spinal stenosis during a 10-year period were retrospectively reviewed. The average age of the 6 male and 4 female patients at surgery was 9.2 years (range 6-16). All patients had preoperative lateral radiographs. Decompression consisted of multilevel (5-8) thoracolumbar laminectomies. More than 50% of each medial facet was preserved bilaterally to maintain spinal stability. RESULTS: Postlaminectomy thoracolumbar kyphoses developed in all 10 patients (100%). The postlaminectomy kyphoses ranged from 78 degrees to 135 degrees (mean 94 degrees ). All patients underwent spinal fusions with instrumentation, performed from 10 months to 2.6 years after the decompressions, to stabilize the kyphoses. CONCLUSIONS: Skeletally immature achondroplasts are at high risk for developing postlaminectomy thoracolumbar kyphoses. Therefore, concurrent spinal fusion is indicated in skeletally immature achondroplasts who undergo thoracolumbar laminectomies of at least 5 levels.

Achondroplasia↗
PubMed2006

Posterior correction and fusion for severe cervical kyphosis in a patient with myotonic dystrophy: a case report.

STUDY DESIGN: A case report. OBJECTIVE: To report the first myotonic dystrophy case in which cervical kyphosis had been surgically corrected. SUMMARY OF BACKGROUND DATA: Myotonic dystrophy is an autosomal dominant disease that shows myotonia, progressive muscle atrophy, and other various symptoms. Instability of the neck is expected to cause disorders of the cervical spine; however, there are no detailed reports on deformity of cervical spine associated with this disease. METHODS: A 43-year-old man with cervical kyphosis due to myotonic dystrophy had undergone an occiput-T2 fusion with autogenous iliac bone using spinal instrumentation. RESULTS: The activity of daily life of the patient had improved markedly, and the good results continued to be preserved for 5 years. There were not any major perioperative complications. CONCLUSIONS: Surgical correction of cervical spine is not necessarily a contraindication for myotonic dystrophy.

Adult↗