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PubMed2006

Postoperative cervical kyphosis after atlantoaxial fixation and cervical expansive laminoplasty at one time.

Cervical kyphotic deformity is one of the well-known complications after atlantoaxial fixation or cervical expansive laminoplasty, but to our knowledge there is no information about postoperative cervical kyphosis after performing these operations simultaneously. The aims of this study were to evaluate the changes in the cervical alignment after simultaneous atlantoaxial fixation and cervical expansive laminoplasty, and to discuss the risk factors of this deformity. Five patients (1 man and 4 women) who underwent the simultaneous procedure were examined. Their mean age at surgery was 68.4+/-3.4 years, and the mean follow-up period was 30.8+/-9.5 months. Their underlying diseases were rheumatoid arthritis, and one of them had athetosis, too. On neutral lateral cervical radiographs, tangents were drawn to the inferior endplates of C2 to C5, respectively, and we measured the angles between C2 and C3, C3 and C4, C4 and C5, and C2 and C5 just after surgery and at the latest follow-up. The mean angles were 2.1, -1.9, 1.8, and 1.2 degrees, respectively, just after surgery; and 2.1, -3.5, -2.6, and -5.8 degrees, respectively, at the latest follow-up. Although the mean angle between C2 and 3 hardly changed postoperatively, the mean angle between C2 and C5 significantly decreased postoperatively. In summary, atlantoaxial fixation and cervical expansive laminoplasty may be an unsuitable combination because cervical kyphosis after the simultaneous procedure developed as a complication during the short-term follow-up.

Aged↗
PubMed2006

Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels.

Local post-traumatic kyphosis may impair spinal sagittal balance and result in severe disability. The goal of this study is to evaluate posterior closing wedge osteotomy at the level of injury, by comparing thoracolumbar (T12-L1) and lumbar (L2-4) spinal levels. Thirteen consecutive patients had surgery in an average 13 months after the initial injury. There were 8 thoracolumbar and 5 lumbar deformities. Nine patients already had posterior fixation. Eight patients had preoperative neurological deficits. Sagittal correction was assessed in terms of regional angulation (RA) and effective regional deformity (ERD), which was defined as the difference between the actual RA and the physiological RA for the level. The average follow up was 2.1 years. The average RA passed from 43.8 degrees (31 to 55) to 2.2 degrees (-5 to 7) after surgery. It was 5.3 degrees (-4 to 12), at follow-up. RA and surgical correction were not significantly different between thoracolumbar and lumbar groups. The average ERD was 47.2 degrees (24 to 66) preoperatively and 8.6 degrees (-5 to 37) at follow-up. The ERD passed from 41.8 degrees (24 to 54) to 0.5 degrees (-5 to 6) in the thoracolumbar group, and from 55.8 degrees (50 to 66) to 21.6 degrees (17 to 37) in the lumbar group. The ERD was significantly different initially (P=0.014) and after surgery (P=0.06). The anatomical result was complete in the thoracolumbar group, because the correction of the deformity at this level does not require more than correction of the vertebral body kyphosis. On the contrary, due to adjacent disc damage, the technique did not fully restore the physiological regional lordosis at lower levels.

Adult↗
PubMed2006

Progressive cervical kyphosis associated with botulinum toxin injection.

Weakness of the neck extensors can lead to "dropped head syndrome", a condition of progressive cervical kyphosis in which a patient is unable to hold their head up against the force of gravity. This condition can be associated with structural abnormalities of the spine as found in ankylosing spondylitis and vertebral fractures. Neuromuscular disorders, such as myasthenia gravis, muscular dystrophies, inflammatory myopathies, and motor neuron disorders such as amyotrophic lateral sclerosis (ALS) have also been reported as etiologies of dropped head syndrome. In this article, we describe an elderly woman with rapidly progressive cervical kyphosis following an injection of botulinum toxin A into her neck extensor musculature.

Aged, 80 and over↗
PubMedDate not supplied

Congenital kyphosis by segmentation defect: etiologic and pathogenic studies.

Sixteen cases of type II congenital kyphosis were reviewed. As a working hypothesis, we assumed that this pathology should have a behavior similar to scoliosis due to a segmentation defect, if a true unsegmented bar existed. The analysis of different parameters including the number of levels involved, the patient's age, the degree of disc space involvement, and the site of deformity did not confirm this hypothesis. Furthermore, an experimental animal study failed to reproduce this congenital anomaly. It is our belief that kyphosis resulting from a "segmentation defect" represents a developmental defect of the perivertebral structures including the annulus fibrosus, the ring apophysis, and the anterior longitudinal ligament rather than a true intervertebral bar.

Adolescent↗
PubMedDate not supplied

Aortic anatomy in children with myelomeningocele and congenital lumbar kyphosis.

Preoperative aortograms were reviewed in six children with thoracic myelomeningocele and lumbar kyphosis at an average age of 25 months. In all children, the abdominal aorta bridged the lumbar kyphosis. In four children, the upper renal poles were close to the spine and were at potential risk during kyphectomy. All children had aortic shortening with an increased variability in origin of the major abdominal aortic branches. Abnormal lumbar arteries were noted in four children.

Aorta↗
PubMedDate not supplied

Comparison of two instrumentation techniques in treatment of lumbar kyphosis in myelodysplasia.

Thirty-three patients with myelodysplasia had kyphectomies for correction of spinal deformities. Harrington compression instrumentation was used for fixation in 21 patients, with postoperative immobilization in a spinal orthosis for 6 months. Twelve patients had Luque rod instrumentation, with fixation through the first sacral foramina with a modification of the Dunn technique and with no postoperative immobilization. Kyphosis recurred in eight patients with Harrington rod instrumentation and in none of those with Luque rod instrumentation. Nine patients with Harrington compression rods required 15 procedures for instrumentation problems. Only five of the 21 patients with Harrington compression rods had no significant complications, although ultimately 20 of 21 patients had solid fusions without further progression of the kyphosis. All 12 patients with Luque rods had solid fusions with no recurrences of the kyphotic deformity. One patient required operation for instrumentation problems.

Adolescent↗
PubMed1994

Prenatal ultrasonographic diagnosis of congenital kyphosis due to anterior segmentation failure.

A few cases of congenital scoliosis due to segmentation failure have so far reported and the antenatal detection of pure congenital kyphosis without scoliosis due to segmentation failure has not been reported. We report the first prenatal identification using ultrasound of a fetus affected with pure congenital kyphosis due to anterior segmentation failure of the vertebral body between the second and third lumbar spine which was associated with ventriculomegaly, cleft palate, and hydramnios.

Adult↗
PubMed1985

Combined idiopathic kyphosis and scoliosis. An analysis of the lateral spinal curvatures associated with Scheuermann's disease.

A radiological study of 50 patients with thoracic Scheuermann's disease revealed two types of lateral spinal curvature. A total of 43 lateral curves was present in 35 of the patients. Thirteen were apical at the same level as the Scheuermann's kyphosis and were due to vertebral-body wedging in the coronal plane; these curves had a mean Cobb angle of 15 degrees, occurred with equal prevalence in boys and girls and were directed equally to right and left. Thirty curves occurred in regions of compensatory lordosis (mean 5.6 degrees) situated above or, more commonly, below the Scheuermann's kyphosis. These scolioses had a mean Cobb angle of 16 degrees, were more often convex to the right than to the left and were significantly more prevalent in girls than in boys. The presence of these kyphoses and scolioses in the same spine, separated by only a few vertebrae, emphasises the importance of the sagittal plane in idiopathic spinal deformities and strongly suggests that idiopathic scoliosis and Scheuermann's disease share a common pathological process.

Adolescent↗
PubMed1992

Aortography in children with myelomeningocele and lumbar kyphosis.

In 21 children with myelomeningocele who underwent kyphectomy for congenital kyphosis of the lumbar spine, aortography revealed no case in which the aorta followed the spinal curvature. Many anomalies of the intercostal and segmental arteries were demonstrated which were only in part associated with deformities of the respective vertebral bodies. The kidneys, which were frequently malformed, often lay within the kyphosis and were therefore at risk of operative damage. We conclude that the aorta is not at risk and that aortography is not usually necessary before kyphectomy, except in patients who have undergone prior abdominal surgery. Non-invasive methods (ultrasound, CT or MRI) should be used to detect malpositions and malformations of the kidneys.

Aorta, Abdominal↗
PubMed2001

The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity.

The progression of post-tubercular kyphosis in 61 children who received ambulatory chemotherapy was studied prospectively. The angles of deformity and kyphosis were measured for each patient at diagnosis, 3, 6, 9, 12 and 18 months later and every year thereafter for 15 years. During the course of the disease signs of instability appeared on the radiographs of some of the children. These were dislocation of the facets, posterior retropulsion of the diseased fragments, lateral translation of the vertebrae in the anteroposterior view and toppling of the superior vertebra. Each sign was allocated one point to create a spinal instability score. The influence on the progression of the deformity of the level of the lesion, the vertebral body loss, the number of segments involved, the angle of deformity before treatment and the spinal instability score was analysed. The mean angle of deformity at the start of treatment was 35 degrees. This increased to 41 degrees at 15 years. Progression occurred during the active phase of the disease and again after cure when variations in progression were observed. Type-I progression showed an increase in deformity until growth had ceased. This could occur either continuously (type Ia) or after a lag period of three to five years (type Ib). Type-II progression showed decrease in deformity with growth. This could occur immediately after the active phase (type IIa) or after a lag period of three to five years (type IIb). Type-III progression showed minimal change during either the active or healed phases and was seen only in those with limited disease. Multiple regression analysis showed that a spinal instability score of more than 2 was a reliable predictor of patients with an increase of more than 30 degrees in deformity and a final deformity of over 60 degrees. Since signs of radiological instability appear early in the disease, they can be reliably used to identify children whose spine is at risk for late progressive collapse. Surgery is advised in these cases.

Adolescent↗
PubMed1982

Surgical treatment of severe angular kyphosis.

Five patients 10-21 years old were treated for severe angular kyphosis, ranging from 61 to 133 degrees, by a three-stage procedure: 1. distraction in a halo-pelvic apparatus, 2. anterior decompression and/or fusion and 3. posterior fusion with Harrington compression rods. An average correction of 68% and a good cosmetic result were obtained. A solid fusion was achieved in all patients. There were no neurological complications. A 12-year-old girl gained 20 cm in height and the spinal kyphosis was reduced from 133 to 27 degrees.

Adolescent↗
PubMed1985

Osteotomy for kyphosis in ankylosing spondylitis.

Twenty-two patients suffering from progressive kyphosis due to ankylosing spondylitis underwent one or more lumbar osteotomies during 1957-1983. The primary thoracic kyphosis was 80 degrees (45 degrees-155 degrees). The mean correction obtained by one level osteotomy was 44 degrees (30 degrees-60 degrees). The mean loss of correction after 3 years was 5 degrees. The use of internal fixation reduced the loss of correction from 9 degrees to 1 degree, also allowing ambulatory after-care and a shorter period of immobilization in plaster or jackets. We had no fatal and relatively few non-fatal complications; three cases of retrograde ejaculation were observed however. All the patients reported subjective respiratory improvement.

Adult↗
PubMed1995

Recurrent kyphosis after posterior stabilization of thoracolumbar fractures. 24 cases treated with a Dick internal fixator followed for 1.5-4 years.

24 patients with Th12-L1 fractures treated with a Dick internal fixator were analyzed to assess predictors of poor outcome. 4 patients had fixation without bone transplantation, 20 patients had a posterior fusion, and 12 of them had additional transpedicular spongioplasty. There were fractures of the transpedicular screws in 4 and screw migration in 2 cases. The increase in the local kyphosis angle was greater than the increase in the anterior compression angle and this did not correlate with spongioplasty or fusion. Fixation failure was in all cases related to a disproportionate increase in the local kyphosis angle. There was no difference between the patients with transpedicular spongioplasty and posterior fusion and the other patients with respect to results and complications. Bony collapse was not the major cause of failure and consequently there was no measureable contribution of transpedicular spongioplasty. We found that the Dick internal fixator for unstable fractures was associated with a higher complication rate than earlier reported.

Adolescent↗
PubMed2000

Multilevel thoracic pedicle aplasia causing congenital thoracic kyphosis: case report.

OBJECTIVE AND IMPORTANCE: Congenital thoracic kyphosis is a rare cause of treatable myelopathy. Multilevel thoracic pedicle aplasia as a cause of this deformity has not been previously reported in the literature. We report a case and describe the surgical management and outcome. CLINICAL PRESENTATION: A 14-year-old boy presented to us with a 4-month history of back pain and slowly progressive spastic paraparesis. Radiographic studies revealed thoracic kyphosis and bilateral aplasia of the pedicles of T4-T8. INTERVENTION: The patient underwent surgical treatment via a posterior approach for decompression of T4-T8, followed by arthrodesis from T2 to T12, using a hook claw construct with multiple points of fixation and autologous bone grafting. CONCLUSION: Congenital vertebral anomalies may be clinically occult, and delayed presentation may occur in adolescence or adulthood. Aplasia of multiple thoracic pedicles can produce kyphotic deformities with neurological compromise. A posterior approach with multiple points of segmental instrumentation can be effective in treating kyphotic deformities that are flexible and of moderate severity (<75 degrees).

Adolescent↗
PubMed1975

Scheuermann's kyphosis. Results of surgical treatment by posterior spine arthrodesis in twenty-two patients.

Twenty-two patients with Scheuermann's kyphosis were treated with correction, Harrington instrumentation (in twenty-one), and posterior spine fusion. This procedure relieved pain and corrected deformity in all patients but loss of correction of 5 degrees or more occurred in sixteen of the twenty-two patients, including all those whose initial kyphosis was greater than 70 degrees. The incidence of complications was so high that this procedure should ordinarily be performed only for disabling pain or spinal cord compression.

Adolescent↗
PubMed1975

Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. A long-term study.

Two hundred and forty-one consecutive anterior spine fusions for tuberculosis were reviewed to determine how often late progressive kyphosis occurred because of disproportionate growth of the posterior and anterior elements. Three of thirty-one patients with objective roentgenographic evidence of solid anterior fusion had an increase in kyphosis. Two of these had findings suggestive of growth retardation of the anterior ring epiphysis above the fusion mass. Posterior-element overgrowth in the third patient could not be excluded as a cause.

Child↗
PubMed2004

Kyphosis of the thoracic and thoracolumbar spine in the pediatric patient: surgical treatment.

Kyphosis of the thoracic or thoracolumbar spine is a common deformity in pediatric and adolescent populations. When it progresses to the point at which nonsurgical treatment is no longer an option, surgery is indicated. Surgical options available for the treatment of different types of pediatric kyphosis of the thoracic and thoracolumbar spine include posterior instrumentation and fusion, posterior instrumentation and fusion combined with anterior fusion, and anterior instrumentation and fusion.

Adolescent↗
PubMedDate not supplied

Surgical treatment of Scheuermann's adult kyphosis: case report.

A 39-year-old woman with severe Scheuermann's kyphosis complaining of back pain was treated surgically. The following operations were performed in stages to correct a fixed kyphosis: (1) total diskectomy through an anterior approach; (2) application of the halo pelvic distraction apparatus; (3) anterior spine fusion following correction by spinal distraction. She was relieved of her complaints and deformity at a 3 year follow-up examination.

Adult↗