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PubMed1983

A longitudinal study of kyphosis in older people.

An index of kyphosis was estimated with a surveyor's flexicurve. A further index measured wedging in vertebral bodies in lateral chest radiographs by expressing the sum of vertical posterior heights of the lower six thoracic vertebral bodies and discs as a percentage of the corresponding anterior heights. Cross-sectional data showed that both indices increased with increasing age in each sex. Longitudinal studies confirmed that the increases were significant but varied widely in size. Although cross-sectional data suggested greater increase in kyphosis with increasing age in women compared with men, longitudinal measurements over five years did not show this. The index of wedging explained 42% and 48% of the variation in the index of kyphosis in men and in women, respectively. Additional effects due to age, detected in women only, added a further 4% to the explained variation, possibly from ageing of soft tissues. The relationship between the indices, and the additional effect of age in women, persisted in five year survivors.

Age Factors↗
PubMed2005

Kyphosis, a rare cause of dysphagia.

Degenerative kyphosis is mostly asymptomatic. When symptomatic, pain and humping of the back are the commonest features. Dysphagia associated with kyphosis is a rare presentation, though it is otherwise common in older people due to various reasons. We report the case of an 81-year-old kyphotic woman who presented with dysphagia. On barium swallow examination, she was found to have an acute bend in the mid-oesophagus leading to narrowing, secondary to the kyphosis.

Aged, 80 and over↗
PubMed1998

Postlaminectomy and postirradiation kyphosis in children and adolescents.

This is a retrospective review of 12 patients treated for severe postlaminectomy and postirradiation kyphosis by one surgeon from 1977 to 1994. The average age of the patients was 15 years with a range from 2 to 35 years. The duration of followup ranged from 24 months to 156 months with an average of 65 months. All patients had undergone multilevel laminectomies or irradiation of the thoracic or lumbar spine for an intraspinal lesion or trauma. The average preoperative kyphosis was 84 degrees and this was reduced to an average of 39 degrees after surgery. There were no pseudarthroses and there was an average loss of correction of 5 degrees. There were no complaints of back pain. Moderately severe but flexible kyphoses were treated in three patients by posterior instrumentation and spinal fusion. The other nine patients had combined anterior release or decompression and fusion combined with posterior instrumentation and spinal fusion. Bracing failed to halt the progressive kyphosis in those patients for whom it had been attempted. The only major complications in this series were two wound infections in patients previously treated with irradiation.

Adolescent↗
PubMed2002

Long multiple struts for severe kyphosis.

The treatment of severe structural kyphosis poses a difficult problem. The use of an anterior fusion has proven to be an integral part of the surgical treatment of any kyphosis. In addition, the use of multiple struts has helped solve the treatment problem in severe kyphosis. The use of multiple struts and the role of vascularized grafts, technical details, complications, and errors and how to prevent them are discussed in the current study.

Adolescent↗
PubMed1988

Free vascularized fibular strut graft in the treatment of kyphosis.

Anterior free vascularized fibular strut grafts were performed in four patients with structural kyphosis, whose curves were: 40 degrees (C3-C7) in a case of Larsen syndrome; 51 degrees (C6-T3) in a postlaminectomy kyphosis; 48 degrees (T9-L2) in a neurofibromatosis; and 125 degrees (T11-L4) in an old tuberculous spondylitis. Bony union at both fibular ends occurred mostly at 12 weeks postoperative. Vascular patency was evaluated by scintigram using 99m TcMDP. All patients showed positive uptake in the shape of the grafted fibula at 1, 3, and 8 weeks postoperative. Without exception, serial roentgenograms demonstrated rapid incorporation of the graft into the vertebral bodies, without any phase of creeping substitution. This method provides stable and long-standing anterior struts, essential in the management of high grades of kyphosis.

Adolescent↗
PubMed1993

Oligosegmental correction of post-traumatic thoracolumbar angular kyphosis.

Seventeen patients with rigid throacolumbar angular kyphosis due to neglected fractures or dislocations were treated by a standardized single-stage monosegmental or bisegmental anterior discectomy and posterior closing extension wedge osteotomy. The two- or three-level reduction-fixation (RF) instrumentation was used posteriorly for correction and fixation. Choosing angled pedicle screws according to preoperative measurements, the method can always correct the kyphosis to the approximate sagittal curvature that is planned to create preoperatively. The average precorrection of thoracolumbar kyphosis was 39 degrees and was restored to 1.2 degrees for an average correction of 37.8 degrees (range, 22 degrees-56 degrees) with subsequent average loss of 1.1 degrees at final follow-up. Before operation, the complaints were slow progression of kyphotic deformities, fatigue, and pain. All these problems were solved by this procedure. Complications were minimal and mild. No neurologic complications occurred. Follow-up averaged 2.8 years. This method can correct rigid post-traumatic thoracolumbar angular kyphoses to normal geometric relationships as planned preoperatively without much negative effect in lumbar motion and any sacrifice of safety.

Adult↗
PubMed1993

One-stage anterior and posterior correction of severe kyphosis of the cervical spine in neurofibromatosis. A case report.

A case is presented of a 29-year-old woman with neurofibromatosis, who had a 100 degrees dystrophic kyphosis of the cervical spine and was successfully treated by a one-stage anterior and posterior correction. Anterior distractive and posterior compressive corrections were simultaneously applied keeping the posterior longitudinal ligament intact. The kyphosis was corrected to 42 degrees. Safety and better results of the one-stage correction of kyphosis is based on a concept of shortening the spinal canal.

Adult↗
PubMed1994

Posterior transvertebral osteotomy for adult thoracolumbar kyphosis.

STUDY DESIGN: A retrospective case study was performed on the single-stage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. SUMMARY OF BACKGROUND DATA: Forty-one consecutive cases in 38 patients available for follow-up, averaging 33 months (range 4-87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had postlaminectomy failed back syndromes with kyphosis. A preoperative neurologic deficit was present in 34% of the cases including two with cauda equina syndrome. METHODS: Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. RESULTS: All cases had solid union at follow-up; 93% maintained correction averaging 35 degrees with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neurologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively; 26 additional surgeries were performed on 18 patients most commonly for pain (x 11) and additional trauma (x 4). The subjective questionnaire results indicated significant patient satisfaction, with 76% stating they would repeat the surgery and 90% recommending it to another. CONCLUSION: This technically demanding high-risk procedure provides an effective and mechanically superior correction for acute angle thoracolumbar kyphosis in selected adult patients, with high subjective satisfaction.

Female↗
PubMed1995

Progressive kyphosis and neurologic compromise complicating spondylothoracic dysplasia in infancy (Jarcho-Levin syndrome).

STUDY DESIGN: This is a case report and review of the literature. OBJECTIVE: To review the orthopedic literature regarding the spinal abnormalities found with spondylothoracic dysplasia, and to present the history and management of severe kyphosis with neurologic impairment in an infant with spondylothoracic dysplasia. SUMMARY OF BACKGROUND DATA: Spondylothoracic dysplasia (Jarcho-Levin syndrome) is a rare form of short-limbed dwarfism characterized by extensive vertebral and chest-wall abnormalities. Although the spinal anomalies generally are radiographically severe, no patient previously reported in the English orthopedic literature has required surgical stabilization. METHODS: The clinical findings, course, and surgical management of an infant with spondylothoracic dysplasia and severe congenital kyphosis are presented. This patient required anterior decompression and anterior/posterior spinal fusion to obtain stabilization. The follow-up from the index surgical procedure was 2 years. RESULTS: The patient underwent an initial anteroposterior fusion and decompression at 5 months of age. She underwent revision of both anteroposterior procedures 7 months later because of pseudarthroses and a progressive kyphosis. Her residual neurologic abnormality was minimal and she appeared to have a stable fusion at 24 months post-index procedure. CONCLUSIONS: The spinal abnormalities associated with spondylothoracic dysplasia may not be as benign as previously reported. Sagittal, as well as frontal, plane deformities may exist secondary to multiple hemivertebrae. Longer life span, possibly due to improved pulmonary care, may increase the incidence of deformities requiring intervention.

Dwarfism↗
PubMed1998

Postlaminectomy kyphosis.

Postlaminectomy kyphosis is a rare but potentially catastrophic complication of laminectomy performed to treat cervical myelopathy. The best strategy for prevention is awareness of the sagittal plane before surgery in patients with cervical spondylotic myelopathy. An understanding of the biomechanical forces placed on the cervical spine, the normal structures contributing to stability and the underlying pathologic process helps in the prevention and ultimate treatment of postlaminectomy kyphosis. This is a review of the risk factors, biomechanics, work-up, and surgical treatment of postlaminectomy kyphosis.

Cervical Vertebrae↗
PubMed2001

Transpedicular wedge osteotomy for correction of thoracolumbar kyphosis in ankylosing spondylitis: experience with 78 patients.

STUDY DESIGN: This is a retrospective study of surgical correction of thoracolumbar kyphosis caused by ankylosing spondylitis. OBJECTIVE: To report the surgical results of thoracolumbar kyphosis deformity corrected with transpedicular wedge osteotomy performed by a single surgeon at a university hospital. SUMMARY OF BACKGROUND DATA: There has not been a large series in the literature reporting on results of the Thomasen-type closing wedge osteotomy for correction of kyphosis deformity secondary to ankylosing spondylitis, nor has two-level osteotomy of this type in one patient ever been described. METHODS: From 1991 through 1998, 92 transpedicular wedge osteotomies were performed in 78 patients with ankylosing spondylitis for correction of fixed flexion deformity of the thoracolumbar spine. RESULTS: The mean amount of correction for each level of osteotomy was 34.5 degrees (range, 15 degrees -60 degrees ). The largest amount of overall correction for a single patient was 100 degrees. Most of the osteotomies (64 of 92) were done at L2 and L3. Fourteen patients with severe deformity required staged two-level osteotomy. Excellent and good results were obtained in 77 patients (98.7%) at the final follow-up. There was no mortality, nor were there any major neurological complications. CONCLUSIONS: Transpedicular wedge osteotomy can effectively and safely correct kyphotic deformity of the thoracolumbar spine caused by ankylosing spondylitis, regardless of rigidity of the spinal curves. Two-level osteotomy can provide sufficient correction for severe cases.

Adult↗
PubMed2001

Surgical treatment of congenital kyphosis.

STUDY DESIGN: In this study, 26 cases of congenital kyphosis and kyphoscoliosis treated surgically were retrospectively reviewed. OBJECTIVE: To assess the clinical outcomes and surgical indications for posterior only versus anteroposterior surgery in the child. SUMMARY OF BACKGROUND DATA: Congenital kyphosis usually is progressive without surgical intervention. Current recommended treatment includes posterior arthrodesis for deformities of less than 50 degrees to 60 degrees, and anterior release or decompression, anterior fusion, and posterior instrumented arthrodesis for large deformities and cord compression. METHODS: Cases involving myelodysplasia, spinal dysgenesis, and skeletal dysplasia were excluded from the study. Kyphoscoliosis was included if the kyphotic deformity was greater than the scoliotic deformity. Patients were grouped by age and surgical technique. The patients in group P1 underwent posterior arthrodesis at an age younger than 3 years, and those in group P2 underwent the procedure at an age older than 3 years. The patients in group AP1 underwent anterior and posterior procedures at an age younger than 3 years, and those in group AP2 underwent the procedures at an age older than 3 years. The preoperative deformity, complications, and postoperative deformity correction were analyzed. There were nine Type 1 (failure of formation), nine Type 2 (failure of segmentation), and eight Type 3 (mixed) deformities. Four patients had associated spinal dysraphism. Three patients with Type 1 deformities had clinical or radiographic evidence of cord compression. RESULTS: In Group P1, five patients at an average age of 16 months underwent posterior arthrodesis alone for an average kyphotic deformity of 49 degrees. The immediate postoperative correction improved over a period of 6 years and 9 months by an additional 10 degrees, resulting in a final deformity of 26 degrees. Pseudarthrosis developed in two patients, requiring fusion mass augmentation or anterior arthrodesis. Neither patient was instrumented. In Group P2, five patients at an average age of 13 years and 7 months underwent posterior arthrodesis with instrumentation for kyphotic deformity of 59 degrees. Approximately 30 degrees of intraoperative correction was achieved safely using compression instrumentation and positioning. No further correction occurred with growth. The final residual kyphotic deformity was 29 degrees after a follow-up period of 4 years and 5 months. In Group AP1, seven patients underwent anterior release or vertebra resection for deformity correction and posterior arthrodesis for an average kyphotic deformity of 48 degrees at the age of 16 months. There were no iatrogenic neurologic injuries. The final residual kyphotic deformity was 22 degrees after a follow-up period of 6 years and 3 months. In Group AP2, nine patients underwent anterior release or decompression with posterior arthrodesis for kyphotic deformity of 77 degrees at the age of 11 years and 6 months. The deformity was corrected to 37 degrees, with no significant loss over a follow-up period of 5 years and 2 months. There were two postoperative neurologic complications. CONCLUSIONS: After reviewing their experience, the authors made the following observations: 1) The pseudarthrosis rate was low even without routine augmentation of fusion mass if instrumentation was used; 2) gradual correction of kyphosis may occur with growth in patients younger than 3 years with Types 2 and 3 deformities after posterior fusion, but appears to be unpredictable; 3) the risk of neurologic injury with anterior and posterior fusion for kyphotic deformity was associated with greater age, more severe deformity, and preexisting spinal cord compromise.

Adolescent↗
PubMed2002

Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis.

STUDY DESIGN: Seven patients with severe angular kyphotic deformity of the spine were treated by circumferential spinal wedge osteotomy using a single posterior approach. OBJECTIVE: To evaluate the surgical outcomes for seven patients with severe angular kyphosis or kyphoscoliosis treated by spinal wedge osteotomy. SUMMARY OF BACKGROUND DATA: Excellent surgical outcomes have been reported for procedures such as hemivertebra excision, vertebral body resection, and spinal osteotomy for angular kyphosis or kyphoscoliosis. However, the safety and efficacy of these procedures for severe and rigid deformities have not been established. METHODS: The surgical procedure involves circumferential exposure of the apex vertebra to the anterior aspect using a single posterior approach. Sparing only the spinal cord, the surgeon performs circumferential wedge bone resection, closure, correction, and stabilization by instrumentation while monitoring the spinal cord. Seven patients (3 kyphotics and 4 kyphoscoliotics) treated by this procedure were evaluated for a minimum of 2 years. Underlying conditions comprised five cases of congenital deformity with hemivertebrae and two cases of skeletal dysplasias. The mean age at surgery was 16.5 years, and the mean follow-up period was 6.9 years. RESULTS: Before surgery, the mean kyphotic curve was 105.4 degrees (range, 68-150 degrees ), and the mean scoliotic curve was 85.3 degrees (range, 60-132 degrees ). After surgery, the curves averaged 48.9 degrees and 40 degrees, respectively, yielding corrections of 52.9% and 54.9%. The mean posterior trunk shift in global sagittal balance was 21 mm before surgery, becoming 3 mm after surgery. Progressive spinal cord dysfunction had developed in three patients before surgery. In all three, postoperative neurologic improvement was observed. Postoperative complications consisted of transient, unilateral leg paresis in two patients. No incidents of infection or pseudarthrosis were observed. CONCLUSIONS: Spinal wedge osteotomy by the single posterior approach is a reliable and safe surgical technique for correcting severe rigid angular kyphosis or kyphoscoliosis.

Adolescent↗
PubMed2003

Anterior fusion and posterior correction of severe cervical kyphosis using pedicle screw fixation in a patient with neurofibromatosis: a case report.

We present a 15-year-old boy with severe cervical kyphosis due to neurofibromatosis (NF), who underwent one-stage anterior fusion and posterior correction using pedicle screw fixation. The kyphosis was corrected from 72 degrees to 35 degrees. At the follow-up 16 months postoperatively, anterior fusion and posterior stabilization had been obtained without correction loss. Cervical pedicle screw fixation is a useful method for the correction of severe cervical kyphosis in patients with NF.

Adolescent↗
PubMed2003

Proximal kyphosis after short posterior fusion for thoracolumbar scoliosis.

Thoracolumbar idiopathic scoliosis usually is treated by anterior spinal fusion. However, short posterior spinal fusion that includes only the structural curve has been tried in a limited number of patients. The fusion may end cranially in the lower thoracic region and cause an increase in sagittal decompensation at the proximal junction. From July 1989 to July 1998, 14 patients were treated with thoracolumbar idiopathic scoliosis by short posterior spinal fusion. The lateral radiographs were evaluated preoperatively, immediately postoperative, and during followup. The focal kyphotic angle was used to examine the changes in focal sagittal alignment. A 10 degrees progression was defined as the radiographic criterion for the development of junctional kyphosis. Proximal junctional kyphosis occurred in six of the 14 patients, in which one patient needed revision surgery. In all six patients, the average preoperative lumbar lordosis was greater than 35 degrees, and decreased more than 10 degrees during surgery. In the five patients with a focal kyphotic angle larger than 10 degrees, four had proximal junctional kyphosis develop. According to the current findings, short posterior spinal fusion can be done only if the focal kyphotic angle proximal to the fusion is less than 10 degrees, and the lumbar lordosis must be preserved carefully during surgery.

Adolescent↗
PubMedDate not supplied

Cervical kyphosis associated with anteroposterior dissociation and quadriparesis in Larsen's syndrome.

Neither the natural history nor the optimal treatment of cervical spine anomalies in Larsen's syndrome has been clearly defined. The authors describe two patients with Larsen's syndrome with cervical kyphosis, anteroposterior dissociation, and quadriparesis to show the variable clinical progression and offer a description of the authors' treatment. One patient has had continued neurologic and radiographic improvement with nonoperative treatment consisting of early traction. The other patient was treated with posterior fusion that failed to halt progressive kyphosis of the anterior vertebral bodies because of anteroposterior dissociation. He then was treated by resection of the posterior fusion, traction, and anterior and posterior decompression and fusion. Cervical kyphosis in patients with Larsen's syndrome is unpredictable, and both nonoperative and operative treatments have the potential to be successful. Anteroposterior dissociation of the cervical spine may be more common in Larsen's syndrome than recognized previously and may profoundly affect operative strategy and outcome.

Cervical Vertebrae↗
PubMed2003

Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture.

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between combined anterior-posterior procedures and posterior closing wedge osteotomy procedures in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures. SUMMARY OF BACKGROUND DATA: Combined anterior-posterior procedures are usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, combined anterior-posterior surgery is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture were indicated for operative intervention using either a combined anterior-posterior surgery (n = 11) or a posterior closing wedge osteotomy procedure (n = 15). The results of the two procedures were analyzed. The average patient age at the operation was 62.6 years (range: 50-82) with a 12:14 male-to-female ratio. Mean follow-up was 3.5 years (range: 2.1-5.4). Preoperative interval from injury to operation was 15.4 months (range: 1-36). There were 20 thoracolumbar (T12-L1) fractures and six lumbar fractures indicated for operative intervention. RESULTS: In the combined anterior-posterior group, the mean operative time was 351 minutes with a mean blood loss of 2,892 mL. In the posterior closing wedge osteotomy group, the mean operative time was 215 minutes with blood loss of 1,930 mL. Eighteen patients showed a postoperative improvement in Frankel grading, 64% (7/11) in the combined anterior-posterior group, and 73% (11/15) in posterior closing wedge osteotomy group. There were no neurologic or vascular complications in either group. In the combined anterior-posterior group, there were five complications: two postoperative pneumonias, one superficial infection, and two distal screw loosening. There were only two complications in the posterior closing wedge osteotomy group: two distal screw loosening. One of the four cases of distal screw loosening required surgical revision. The other three cases were treated by bracing for more than 6 months. CONCLUSIONS: Although technically demanding, the posterior closing wedge osteotomy procedure demonstrated a better surgical result with significant less mean operative time and mean blood loss (P < 0.05). It may be a better alternative than a combined anterior-posterior procedure in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture.

Accidental Falls↗
PubMed2004

Hypotension-induced loss of intraoperative monitoring data during surgical correction of scheuermann kyphosis: a case report.

STUDY DESIGN: Presentation of a case report of Scheuermann kyphosis surgical correction. OBJECTIVE: To describe a scenario where both neurogenic mixed evoked potentials and somatosensory-evoked potentials were lost due solely to hypotension before any correction of a kyphotic spinal deformity was performed. SUMMARY OF BACKGROUND DATA: Multimodality intraoperative neurophysiologic monitoring of the spinal cord has become widely utilized during surgical correction of scoliotic and kyphotic deformities. Most spinal surgeries also benefit from a state of hypotension to minimize blood loss, but unchecked and persistent hypotension may lead to inadequate perfusion to the spinal cord, resulting in spinal cord dysfunction noted by diminution of neuromonitoring data. METHODS: An 18-year-old boy with a 95 degrees Scheuermann kyphosis underwent a posterior spinal fusion for correction of his deformity. Intraoperative neurophysiologic monitoring consisting of neurogenic mixed evoked potentials and somatosensory-evoked potentials were performed throughout surgery. RESULTS: After placement of segmental pedicle screw fixation points and multiple osteotomies, before any instrumented correction of the deformity, all lower extremity neuromonitoring data were acutely lost. The surgeon was immediately warned of the data loss, with the mean arterial pressure noted to be 50 mm Hg. The mean arterial pressure was raised with the use of epinephrine bolus and dopamine infusion. Subsequently, all lower extremity neuromonitoring data returned. A Stagnara wake-up test was performed, which the patient passed, and the surgical correction was performed with his pressure maintained on a dopamine infusion. He awakened without neurologic deficits and had an uneventful recovery. CONCLUSIONS: Although a state of mild hypotension may be beneficial to limit blood loss during spinal deformity corrective surgery, acute and/or prolonged hypotension may jeopardize spinal cord vascularity and should be avoided especially during surgical treatment of high-risk deformities such as kyphosis. Early warning by multimodality physiologic neuromonitoring appears to be a useful method to alert surgeons of the potentially devastating problem of hypotension-induced spinal cord dysfunction and allows immediate corrective actions.

Adolescent↗