Treatment Of Congenital Kyphoscoliosis Research Articles

Outcomes of 360° Osteotomy in the Cervicothoracic Spine (C7-T1) for Congenital Cervicothoracic Kyphoscoliosis in Children.

There have been many reports on the treatment of congenital kyphoscoliosis. However, congenital deformities in the cervicothoracic spine (C7-T1) have not been well described because of the rarity of these conditions. The medical records and imaging studies of 25 children who were treated with 360° osteotomy for congenital deformities in the cervicothoracic spine (C7-T1) at a mean age of 11.4 years were reviewed. All 25 children presented with torticollis; 4 presented with neck pain; 10, with facial asymmetry; and 3, with preoperative neurological deficits. Twenty-three patients had congenital deformities in other regions of the spine. Six patients had a total of 8 intraspinal deformities. On average, the cervicothoracic curve was corrected from 53° preoperatively to 14° at the latest follow-up, the segmental kyphosis was corrected from 25° to 12°, and the head tilt improved from 25° to 5°. Nineteen patients had a total of 28 complications, including 1 transient cord injury together with a permanent C8 nerve root injury, 11 transient nerve root injuries, 1 transient Horner syndrome, 9 cases of decompensation of a compensatory curve, 2 implant failures, 2 cases of hemothorax, 1 dural tear, and 1 case of delayed wound-healing. Most congenital cervicothoracic deformities are fixed, and early surgical intervention may be needed. A 360° osteotomy is indicated for this type of rigid deformity and may provide satisfactory correction. However, 360° osteotomy in the cervicothoracic spine (C7-T1) is technically demanding with a higher risk of nerve root injuries, although most injuries tend to be transient. If the compensatory thoracic curve is severe and rigid, 1-stage or staged surgery in this region may be required. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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Study Design Presentation of a clinical case. Object A clinical case of severe congenital kyphoscoliosis in an11-year-old child treated surgically. Method Vertebrotomy beyond the anomaly zone with the PSO technique and dynamic fixation of the spine. Result Correction of spinal deformity. Discussion Surgical treatment of congenital kyphoscoliosis with the PSO technique out the zone of congenital anomaly and implantation of dynamic systems achieve an orthopedic goal with a single intervention via a single approach.

Posterior all-pedicle screw instrumentation combined with multiple chevron and concave rib osteotomies in the treatment of adolescent congenital kyphoscoliosis

Background contextCongenital kyphoscoliosis is a disorder that often requires surgical treatment. Although many methods of surgical treatment exist, posterior-only vertebral column resection with instrumentation and fusion seem to have become the gold standard for very severe and very rigid curves. Multiple chevron and concave rib osteotomies have been previously reported to be effective in the treatment of neglected severe idiopathic curves. We hypothesized that this method may also be used successfully in the treatment of congenital kyphoscoliosis. PurposeTo evaluate the effectiveness and safety of multiple chevron osteotomies combined with concave rib osteotomy and posterior pedicle screw instrumentation. Study designRetrospective chart review in the spine service of a large university hospital. Patient sampleAdolescent patients undergoing a specific surgical treatment for the indication of rigid congenital kyphoscoliotic deformity. Outcome measuresRadiographic images were used for the measurement of deformity correction. The Turkish version of the Scoliosis Research Society 22 (SRS-22) Patient Questionnaire has been used as a clinical outcome measure in the patient population. MethodsA retrospective chart review was performed. Patients admitted to Hacettepe Hospital Spine Center during the period of 2005 to 2009 were included. Criteria for inclusion were as follows: adolescent age group (10–16 years); congenital kyphoscoliosis; formation and/or segmentation defect of at least two vertebral motion segments; surgical treatment of deformity by posterior all-pedicle screw instrumentation, multiple chevron osteotomies, and multiple concave rib osteotomies; follow-up of at least 24 months; and a complete set of preoperative, postoperative, and follow-up standing posteroanterior and lateral full spinal radiographs. The patients' hospital records and X-rays were reviewed. Duration of surgery, intraoperative blood loss, postoperative transfusion requirements, postoperative stay in postanesthesia care unit (PACU), time of hospitalization, and complications were recorded. Deformity in both coronal and sagittal planes was analyzed for correction and maintenance of the correction in preoperative, postoperative, and follow-up radiographs. Patients' health-related quality of life was assessed using the SRS-22 questionnaire at the final follow-up. ResultsEighteen patients met the inclusion criteria. Their average age was 13.6 years (range, 11–16 years). Chevron osteotomies were performed at apical segments (three to seven levels) and concave rib osteotomies at Cobb-to-Cobb (five to eight levels). No patient had preoperative cord compression because of the sharply angulated deformity or neurologic deficit. The average preoperative scoliosis was 66.0° (range, 31°–116°), 52.4° (range, 22°–85°) on flexibility X-rays, and became 24.9° (range, 12°–52°) postoperatively. The average preoperative global kyphosis (T2–T12) of 75.9° (range, 50°–106°) became 49.5° (range, 18°–66°). The average preoperative local kyphosis of 71.9° (range, 35°–114°) became 31.4° (range, −44° to 64°). The average intraoperative bleeding was 989 cc, surgical time was 292 minutes, and intraoperative transfusion was 2.3 units. The maximum PACU stay was overnight. There were no neurologic complications except one pneumothorax and one pneumonia. The average follow-up was 34.3 months. At follow-up, average scoliosis was 27.5° (range, 10°–50°), global kyphosis was 50.3° (range, 28°–73°), and local kyphosis was 36.9°(range, −36° to 58°). Performed on the last follow-up, the average scores for the five domains of SRS-22 were 4.3, 4.4, 4.2, 4.1, and 4.8 for function, pain, self-image, mental health, satisfaction, and total, respectively. ConclusionsMultiple chevron and concave rib osteotomies with posterior instrumentation provide an acceptable rate of deformity correction and maintenance of correction at 2 years with acceptable intraoperative bleeding, surgical time, postoperative morbidity, and rate of complications. It can be considered as an alternative in the treatment of rigid congenital curves involving more than three levels or multiple curves separated by at least two segments that would otherwise require multiple vertebral resections.

Simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kyphosociolis caused by fully-segmented hemivertebra.

Objective To evaluate the long-term results of simultaneous anterior and posterior hemivertebra resection in the treatment of congenital kypho-scoliosis caused by fully-segmented hemivertebra. Methods Twenty consecutive cases, 10 males and 10 females, underwent one-stage anterior and posterior hemivertebra resection and instrumentation. All the hemivertebra were fully-segmented. The average age at surgery was 11.7 years, ranging from 5 to 16 years, and the average follow-up was 40.5 months, ranging from 24 to 72 months. Full-length standing radiographs were taken before and after surgery and at the final follow-up. The apical translation, the Cobb angle in the coronal and sagittal plane were measured and analyzed. The medical records were reviewed and the complications were recorded. The hemivertebra was located at T5, T7, L1, L2 in each 1 ease, T6, T10 in each 3 cases, T9 in 4 cases, T11 T12, L3 in each 2 cases. Results The average operative time was 315 min with a mean 798 ml of blood loss. The Cobb angle in the coronal plane was corrected from 61.7° to 18.3°, with a 70.3% of correction rate. The kyphosis was corrected from 48.2° to 16.6°. Apical translation was improved from 3.7 cm to 1.9 cm. The average fusion segments was 4.7, ranging from 2 to 9 segments. Complications included pediculus cutting in 1 case, lumbar curve decompensation in 1 case and crankshaft phenomenon in 2 cases. Conclusion Simultaneous anterior and posterior hemivertebra resection is a safe and effective procedure for delete congenital kypho-scoliosis caused by fully-segmented hemivertebra. Anterior epiphysiodesis is necessary to avoid crankshaft phenomenon for patients at an earlier skeletal age. Key words: Scoliosis; Kyphosis; Spinal fusion; Internal fixators

Surgical Treatment of Congenital Kyphoscoliosis

Surgical Treatment of Congenital Kyphoscoliosis