Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series
https://doi.org/10.14531/2018.4.15-20
Abstract
Objective. To describe the original technical surgical procedure simplifying the correction of kyphosis in children due to instrumental distraction of the anterior column of the spine, to analyze its effectiveness in the setting of clinical series. Level of evidence – IV.
Material and Methods. The study included 9 patients aged 7 months to 14 years (median age: 4 years 8 months) with angular kyphosis (median magnitude 53°, min – 38°, max – 80°) associated with tuberculous (n = 4) and non-specific (n = 4) spondylitis and with a sequelae of spinal cord injury (n = 1). Deformity correction was achieved using temporary instrumental interbody distraction followed by anterior fusion with titanium mesh cage filled with autologous bone graft during a single-step two-stage reconstruction and stabilization surgery.
Results. The duration of surgery was 3 hours 2 min ± 44 min, the volume of blood loss – 190 ml ± 39 ml. In all cases, the deformity was corrected by 75–85 % with restoration of physiological thoracic kyphosis and spinal profile.
Conclusion. A safe and effective technique for intraoperative anterior instrumental distraction can be used to correct angular kyphosis in children, including infants.
About the Authors
A. Yu. Mushkin
St. Petersburg Research Institute of Phthisiopulmonology; North-West State Medical University n.a. I.I. Mechnikov
Russian Federation
Russian Federation
DMSc, Prof., chief researcher, Head of Clinic of Pediatric Surgery and Orthopedics, «Extrapulmonary Tuberculosis» Prospect Research Coordinator
Politekhnicheskaya str., 32, St. Petersburg, 194064
Professor of Pediatric Traumatology and Orthopaedics
Piskarevsky ave., 47, St. Petersburg, 195067
D. G. Naumov
St. Petersburg Research Institute of Phthisiopulmonology
Russian Federation
Russian Federation
Resident, Clinic of Pediatric Surgery and Orthopedics
Politekhnicheskaya str., 32,, St. Petersburg, 194064
V. I. Zorin
St. Petersburg Research Institute of Phthisiopulmonology; North-West State Medical University n.a. I.I. Mechnikov
Russian Federation
Russian Federation
MD, PhD, Clinic of Pediatric Surgery and Orthopedics
Politekhnicheskaya str., 32, St. Petersburg, 194064
Assistant of the Pediatric Surgery
Piskarevsky ave., 47, St. Petersburg, 195067
M. S. Serdobintsev
St. Petersburg Research Institute of Phthisiopulmonology
Russian Federation
Russian Federation
DMSc, Prof., leading researcher, «Bone and Joint Surgery and Orthopedic» Prospect Coordinator
Politekhnicheskaya str., 32, St. Petersburg, 194064
References
1. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V. The comprehensive anatomical spinal osteotomy classification. Neurosurgery. 2014;74:112–120. DOI: 10.1227/NEU.0000000000000182o.
2. Kim KT, Lee SH, Suk KS, Lee JH, Jeong BO. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine. 2012;37:1667–1675. DOI: 10.1097/BRS.0b013e3182552fd0.
3. Xi YM, Pan M, Wang ZJ, Zhang GQ, Shan R, Liu YJ, Chen BH, Hu YG. Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol. 2013;23 Suppl 1:59–66. DOI: 10.1007/s00590-013-1168-3.
4. Rajasekaran S, Vijay K, Shetty AP. Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J. 2010;19:583–592. DOI: 10.1007/s00586-009-1234-z.
5. Xia L, Li P, Wang D, Bao D, Xu J. Spinal osteotomy techniques in management of severe pediatric spinal deformity and analysis of postoperative complications. Spine. 2015;40:286–292. DOI: 10.1097/BRS.0000000000000728.
6. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, Shah SA, Sides BA, Blanke KM. Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine. 2013;38:119–132. DOI: 10.1097/BRS.0b013e318269fab1.
7. Abdeen K. Efficacy of titanium mesh cages for anterior column reconstruction after thoracolumbar corpectomy. Asian Spine J. 2016;10:85–92. DOI: 10.4184/asj.2016.10.1.85.
8. Fukuda K, Miyamoto H, Uno K, Okada Y. Indications and limitations of conservative treatment for pyogenic spondylitis. J Spinal Disord Tech. 2014;27:316–320. DOI: 10.1097/BSD.0b013e31825d6aca.
9. Mavrogenis AF, Megaloikonomos PD, Igoumenou VG, Panagopoulos GN, Giannitsioti E, Papadopoulos A, Papagelopoulos PJ. Spondylodiscitis revisited. EFORT Open Rev. 2017;2:447–461. DOI: 10.1302/2058-5241.2.160062.
10. Abulizi Y, Liang WD, Maimaiti M, Sheng WB. Smith-Petersen osteotomy combined with anterior debridement and allografting for active thoracic and lumbar spinal tuberculosis with kyphotic deformity in young children: A prospective study and literature review. Medicine (Baltimore). 2017;96:e7614. DOI: 10.1097/MD.0000000000007614.
11. Jeszenszky D, Haschtmann D, Kleinstuck FS, Sutter M, Eggspuhler A, Weiss M, Fekete TF. Posterior vertebral column resection in early onset spinal deformities. Eur Spine J. 2014;23:198–208. DOI 10.1007/s00586-013-2924-0.
12. Helenius I, Serlo J, Pajulo O. The incidence and outcomes of vertebral column resection in paediatric patients: a population-based, multicentre, follow-up study. J Bone Joint Surg Br. 2012;94:950–955. DOI: 10.1302/0301-620X.94B7.28545.
13. Rajasekaran S, Rajoli SR, Aiyer SN, Kanna R, Shetty AP. A classification for kyphosis based on column deficiency, curve magnitude, and osteotomy requirement. J Bone Joint Surg Am. 2018;100:1147–1156. DOI: 10.2106/JBJS.17.01127.
14. Zhou T, Li C, Liu B, Tang X, Su Y, Xu Y. Analysis of 17 cases of posterior vertebral column resection in treating thoracolumbar spinal tuberculous angular kyphosis. J Orthop Surg Res. 2015;10:64. DOI 10.1186/s13018-015-0195-7.
15. Hong-Qi Z, Yong C, Jia H, Chaofeng G, Xiongke H. Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature. Childs Nerv Syst. 2015;31:1347–1354. DOI 10.1007/s00381-015-2738-y.
Review
For citations:
Mushkin A.Yu., Naumov D.G., Zorin V.I., Serdobintsev M.S. Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series. Russian Journal of Spine Surgery (Khirurgiya Pozvonochnika). 2018;15(4):15-20. https://doi.org/10.14531/2018.4.15-20
Email this article 