The posterior surgical correction of congenital kyphosis (under 10 years old)

English Keywords:Kyphosis  Osteotomy  Posterior correction  Congenital deformity  Pedicle screws

English Abstract:

  【Abastract】 Objectives: To evaluate the outcomes of operative results of congenital kyphosis patients who were under 10 years old and underwent posterior osteotomies. Methods: From October 2009 to May 2013, 17 congenital kyphosis patients(6 males, 11 females) who underwent posterior osteotomy in our institution were investigated restrospectively. The average age was 64±21 months(37-109 months) at operation. According to Winter classification, 8 cases were type Ⅰ, 4 cases were type Ⅱ, and 5 cases were type Ⅲ. The apex vertebrae were located between T10 and L2 in all patients. Associated intraspinal anomalies were involved in 5 cases. Operation time, intraoperative blood loss and perioperative complications were recorded. The correct effect, instrumentation related complication and spinal fusion were measured. Results: The mean operation time was 210±46min(range, 130-300min)． The mean blood loss was 650±330ml(range, 200-1300ml)． The mean fusion level was 4.9±0.8(range, 4-6)． The mean follow-up period was 34.7±10 months(range, 24-51 months)． The average preoperative regional kyphosis angle was 61.5°±14.3°(42°-92°), which decreased to 20.7°±9.0°(5°-42°) postoperatively with a correction rate of (66.3±8.7)％, and to 17.5°±9.5°(1°-36°) with a correction rate of (71.5±10.7)％ at last follow-up. There was significant improvement of regional kyphosis postopratively and at last follow-up(P＜0.01). The sagittal balance was -41.3±31.8mm preoperatively, -43.5±30.4mm postoperatively and -25.6±26.7mm at last follow-up. There was no statistical difference in sagittal balance at pre- and postoperation(P＞0.05), while the sagittal balance at last follow-up showed significant improvement compared with that befroe opetation(P＜0.05). Complications after surgery included muscle weakness of bilateral lower limbs in one case and dysuria in one case, and both healed within 2 weeks． Five cases with back pain and one case with urinary incontinence before operation had relieved 6 months after operation. One case developed proximal junctoinal kyphosis 7 months after operation. No pseudarthrosis and implant related complications happened during follow-up. Conclusions: Early spinal osteotomy and pedicle screws fixation can achieve compatible and satisfactory correction results on congenital kyphosis. The spinal saggital balance cannot be achieved immediately after surgery in the majority of cases, but they have a tendency of rebalance during the following years.