Correction of pediatric cervical kyphosis with standalone posterior approach-a single-center experience of seven cases.

Abstract

To study clinical and radiological outcomes of pediatric cervical kyphosis correction with a standaloneposterior cervical approach. Cervical spine kyphotic deformity in pediatric age group is a distinct entity and themanagement is challenging. Pediatric cervical kyphosis is less often encountered, and literature is sparse with onlyfew case series. Management algorithms are devised keeping the flexibility of the deformity at the core of decisionmaking. Circumferential fusion is mostly recommended for non-flexible (rigid) kyphosis. Authors present a single center retrospective analysis of cases of pediatric cervical kyphosis managed bya standalone posterior approach. Pre- and post-operative clinical and radiological parameters were recorded andanalyzed. Changes in neurological status, kyphosis correction and bony fusion were assessed. Surgical andimplant related complications were noted. Seven cases (6 male, 1 female) were included. Mean age was 13.9±2.9 years, ranging from 8-17 years.Etiology was traumatic in 2 cases, developmental in 2, and syndromic, Hirayama disease and post-laminectomy in1 case each. Mean kyphosis correction was 36.80±19.30 (87%±21%) with a mean pre-operative kyphosis angle of37.80±15.30 and mean immediate post-operative kyphosis angle of 3.70±8.70. Mean hospital stay duration was10±6 days. Median follow-up duration was 36 months. Myelopathy improved in 5 cases at last follow-up. Six casesdemonstrated bony fusion at a mean follow-up of 8.4±1.5 months. Significant immediate correction in pediatric cervical kyphosis may be achieved with a standaloneposterior approach with proper planning and technique in selected cases. Inserting pedicle screws at strategiclocations of implant construct offer better corrections and pull-out strength and maintain long-term stability resultingin higher arthrodesis rates. Larger studies with longer follow up are needed to further ascertain the role ofstandalone posterior cervical approaches in pediatric cervical kyphosis.