Surgical treatment of cervical kyphosis in children

English Keywords:Cervical kyphosis  Children  Surgical treatment  Curative effect

English Abstract:

  【Abstract】 Objectives: To explore the method and curative effect of surgical treatment of cervical kyphosis in children. Methods: 9 patients with cervical kyphosis treated surgically in Beijing Children′s Hospital from January 2014 to January 2018 were analyzed retrospectively. There were 5 males and 4 females, with an average age of 5.32±4.48 years ranging from 11 months to 14 years. The etiologies included: neurofibromatosis (2 patients), congenital malformation(4 patients), iatrogenic malformation(1 patients), tuberculousis malformation (1 patient), and osteogenesis imperfect(1 patient). Neck pain was noted in 8, neurological impairment in 5(ASIA grade: 2 cases of grade C and 3 of grade D), cervical dislocation in 2, and scoliosis in 2. Corrective surgery through anterior approach was performed in 5 cases, and combined anterior-posterior approach in 4 patients, with 2 cases in one-stage and 2 cases in two-stage(traction after release). Halo traction was carried out preoperatively in 2 cases, skull traction in 1 case, suspension traction in 1 case, and balanced suspension traction in 2 cases. The change of kyphosis curvature was measured by Cobb angle. Parameters including kyphosis levels, the apex of the curvature, the Cobb angle were measured on lateral radiographs of neutral position of each patient. The preoperative and postoperative changes of various parameters were compared. The correction rate was calculated and evaluated. Results: All patients underwent the operation successfully without complications of nerve, blood vessel and organ injury. For single anterior approach group, the average Cobb angle was 45°-85°(72°±16°) preoperation and corrected to 0°-30°(12.6°±14.1°) postoperation with a correction ratio of 63%-100%[(83±19)%]. In the group of combined anterior-posterior approach surgery, the average Cobb angle was 40°-85°(55°±20°) before surgery and 0°-30°(16.3°±12.5°) after surgery with a correction ratio of 33%-100%[(64±28)%]. All patients were followed up for 3-6 years(4±1 years), and bony fusion was achieved at 3 months after operation for all the fusion segments. There were no loss of correction and failure of internal fixation, 4 cases had adjacent segment degeneration and 3 cases had junctional kyphosis. At the last follow-up, nervous function had recovered to grade E. Conclusions: The appropriate surgical strategy customized for the individual conditions of different etiology and pathology can achieve good results in the treatment of cervical kyphosis for children. In the long run, there may be a relative higher risk of adjacent segment degeneration and distal junctional kyphosis in this immature population.