[Surgical Treatment of Kyphosis in Children and Adolescents]

Overview

Journal Oper Orthop Traumatol

Publisher Springer

Specialties Emergency Medicine
Orthopedics

Date 2023 Sep 13

PMID 37704775

Authors

C E Heyde

N von der Hoh

A Volker

Affiliations

Soon will be listed here.

Abstract

Objective: Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine.

Indications: Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar.

Contraindications: No specific, but general contraindications for surgical treatment.

Surgical Technique: Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques.

Postoperative Management: The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance.

Results: The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.

References

Akbar M, Wiedenhofer B . [Correction of adolescent kyphosis. What is the state of the art?]. Orthopade. 2011; 40(8):682-9. DOI: 10.1007/s00132-011-1799-1. View

Betz R . Kyphosis of the thoracic and thoracolumbar spine in the pediatric patient: normal sagittal parameters and scope of the problem. Instr Course Lect. 2004; 53:479-84. View

Chen S, Chen P, Huang T, Ko J, Wang C . Surgical correction of postradiation spinal deformity. Chang Gung Med J. 2003; 26(3):160-9. View

Cornips E, Koudijs S, Vles J, van Rhijn L . Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon. Childs Nerv Syst. 2017; 33(6):973-981. PMC: 5486534. DOI: 10.1007/s00381-017-3389-y. View

Diab M, Franzone J, Vitale M . The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop. 2010; 31(1 Suppl):S88-98. DOI: 10.1097/BPO.0b013e3181f73bd4. View

Diebo B, Liu S, Lafage V, Schwab F . Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol. 2014; 24 Suppl 1:S11-20. DOI: 10.1007/s00590-014-1471-7. View

Gokcen B, Yilgor C, Alanay A . Osteotomies/spinal column resection in paediatric deformity. Eur J Orthop Surg Traumatol. 2014; 24 Suppl 1:S59-68. DOI: 10.1007/s00590-014-1477-1. View

Gonzalez-Galvez N, Gea-Garcia G, Marcos-Pardo P . Effects of exercise programs on kyphosis and lordosis angle: A systematic review and meta-analysis. PLoS One. 2019; 14(4):e0216180. PMC: 6488071. DOI: 10.1371/journal.pone.0216180. View

Horn S, Poorman G, Tishelman J, Bortz C, Segreto F, Moon J . Trends in Treatment of Scheuermann Kyphosis: A Study of 1,070 Cases From 2003 to 2012. Spine Deform. 2018; 7(1):100-106. PMC: 7102192. DOI: 10.1016/j.jspd.2018.06.004. View

10.

Huq S, Ehresman J, Cottrill E, Ahmed A, Pennington Z, Westbroek E . Treatment approaches for Scheuermann kyphosis: a systematic review of historic and current management. J Neurosurg Spine. 2019; 32(2):235-247. DOI: 10.3171/2019.8.SPINE19500. View

11.

Lenke L . Kyphosis of the thoracic and thoracolumbar spine in the pediatric patient: prevention and treatment of surgical complications. Instr Course Lect. 2004; 53:501-10. View

12.

Lowe T . Kyphosis of the thoracic and thoracolumbar spine in the pediatric patient: surgical treatment. Instr Course Lect. 2004; 53:493-500. View

13.

Lykissas M, Crawford A, Jain V . Complications of surgical treatment of pediatric spinal deformities. Orthop Clin North Am. 2013; 44(3):357-70, ix. DOI: 10.1016/j.ocl.2013.03.007. View

14.

Mac-Thiong J, Labelle H, Roussouly P . Pediatric sagittal alignment. Eur Spine J. 2011; 20 Suppl 5:586-90. PMC: 3175924. DOI: 10.1007/s00586-011-1925-0. View

15.

Miladi L . Round and angular kyphosis in paediatric patients. Orthop Traumatol Surg Res. 2013; 99(1 Suppl):S140-9. DOI: 10.1016/j.otsr.2012.12.004. View

16.

Noordeen M, Garrido E, Tucker S, Elsebaie H . The surgical treatment of congenital kyphosis. Spine (Phila Pa 1976). 2009; 34(17):1808-14. DOI: 10.1097/BRS.0b013e3181ab6307. View

17.

Patel A, Ruparel S, Dusad T, Mehta G, Kundnani V . Posterior-approach single-level apical spinal osteotomy in pediatric patients for severe rigid kyphoscoliosis: long-term clinical and radiological outcomes. J Neurosurg Pediatr. 2018; 21(6):606-614. DOI: 10.3171/2017.12.PEDS17404. View

18.

Rajasekaran S, Kanna P, Shetty A . Closing-opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis. Eur Spine J. 2010; 20(3):343-8. PMC: 3048222. DOI: 10.1007/s00586-010-1526-3. View

19.

Sardar Z, Ames R, Lenke L . Scheuermann's Kyphosis: Diagnosis, Management, and Selecting Fusion Levels. J Am Acad Orthop Surg. 2018; 27(10):e462-e472. DOI: 10.5435/JAAOS-D-17-00748. View

20.

Schroeder M, Viezens L, Kunkel P, Ridderbusch K, Hissnauer T, Jungesblut O . Posterior Only Vertebral Column Resection for the Treatment of Severe Spinal Deformities in Pediatric Patients: A Retrospective Case Series. World Neurosurg. 2017; 101:425-430. DOI: 10.1016/j.wneu.2017.01.118. View