RESUMEN
STUDY DESIGN: Retrospective case series. OBJECTIVE: To elucidate the postoperative course of sagittal alignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis. Acquisition of acceptable sagittal alignment is essential to treat spinal deformity. Little evidence exists regarding long-term surgical outcomes on sagittal alignment in congenital kyphosis or kyphoscoliosis. METHODS: Sixteen consecutive patients (mean age 10.5 ± 3.5 years) with congenital kyphosis or kyphoscoliosis who underwent vertebra resection and osteotomy with instrumentation by single posterior or combined anterior and posterior approach were included. Preoperative radiographs identified kyphosis in 3 patients and kyphoscoliosis in 13 patients. All patients had clinical and radiologic follow-up for > 10 years (mean 16.3 ± 4.0 years). RESULTS: Segmental kyphosis was significantly improved from 33.9° ± 20.1° to 14.9° ± 17.6° by surgery and was finally maintained at 16.8° ± 22.2° and sagittal vertical axis (SVA) of 13.1 ± 33.7 mm at preoperation and 18.3 ± 22.1 mm at postoperation significantly increased to 26.8 ± 45.7 mm during follow-up. Of the 16 patients, 5 (31%) were identified as those with SVA > 40 mm, and SVA increases > 30 mm during follow-up. In patients with sagittal malalignment, radiographs demonstrated decreased lumbar lordosis at the lower foundation from 28.8° ± 39.0° to 17.0° ± 17.6°, significant increased pelvic tilt from 25.8° ± 5.4° to 37.4° ± 7.4° during follow-up (p < 0.05), and larger residual segmental kyphosis than those in the 11 patients without sagittal malalignment with statistical significance. Of the five cases, progression of local kyphosis (one case) and sagittal decompensation, including decreased lumbar lordosis with disc degeneration (four cases), increased pelvic tilt (three cases), or proximal junctional kyphosis (two cases), were observed. CONCLUSION: Based on this > 10-year follow-up study, residual kyphosis and sagittal decompensation are revealed to be risk factors for postoperative sagittal malalignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis. LEVEL OF EVIDENCE: Level IV, case series.
Asunto(s)
Desviación Ósea/etiología , Cifosis/cirugía , Vértebras Lumbares/cirugía , Procedimientos Ortopédicos , Osteotomía , Complicaciones Posoperatorias/etiología , Enfermedad de Scheuermann/cirugía , Escoliosis/cirugía , Fusión Vertebral/métodos , Vértebras Torácicas/cirugía , Adolescente , Desviación Ósea/diagnóstico por imagen , Niño , Femenino , Estudios de Seguimiento , Humanos , Cifosis/congénito , Cifosis/diagnóstico por imagen , Lordosis/diagnóstico por imagen , Lordosis/etiología , Masculino , Complicaciones Posoperatorias/diagnóstico por imagen , Estudios Retrospectivos , Enfermedad de Scheuermann/congénito , Enfermedad de Scheuermann/diagnóstico por imagen , Escoliosis/congénito , Escoliosis/diagnóstico por imagen , Factores de Tiempo , Resultado del TratamientoRESUMEN
STUDY DESIGN: Retrospective study with clinical and radiologic evaluation of 15 patients with congenital kyphosis or kyphoscoliosis who underwent anterior instrumented spinal fusion for posterolateral or posterior hemivertebra (HV). The management of congenital kyphosis has been described in the literature using a variety of techniques. The presentation of patients at diagnosis is discussed. The question of when to begin treatment is reviewed. The pitfalls in the management and how to avoid these are discussed. The different published techniques are reviewed. We present our own techniques and our results of treatment of congenital kyphosis in very young children. OBJECTIVE: To evaluate the safety and efficacy of early surgical anterior instrumented fusion with partial preservation of the HV in the treatment of progressive congenital kyphosis in children below the age of 3. We discuss the management of patients presenting with neurologic compromise. We aim to systematically review the literature and to present our own experience in the management of these deformities, so that the issues common to treating physicians may be explored. SUMMARY OF BACKGROUND DATA: A variety of treatments have been described in the literature for the treatment of congenital kyphosis due to HV. We report the results of our technique. METHODS: Between 1997 and 2005 we have treated 15 consecutive patients with progressive congenital kyphosis with anterior instrumented fusion and strut grafting. Thirteen patients had a single posterolateral HV and 2 patients had a single posterior HV. Of the 15 patients in the study, 5 were girls and 10 boys. Mean age at surgery was 22 months (range, 8-33). Mean follow-up period was 6.8 years. Thirteen HV were located in the thoracolumbar junction (T10-L2) and 2 in the thoracic spine. RESULTS: The average operating time of procedure was 150 minutes (range, 130-210 minutes). The average blood loss was 180 mL (range, 100-330 mL), equivalent to a mean external blood volume loss of 15% (range, 11%-24%).Preoperative segmental Cobb angle averaging 34 degrees at last follow-up. Compensatory coronal cranial and caudal curves were corrected by 50%. The angle of segmental kyphosis averaged 39 degrees (range, 20 degrees-80 degrees) before surgery and 21 degrees (range, 11 degrees-40 degrees) at last follow-up. This represents a 43% of improvement of the segmental kyphosis, and a 64% of improvement of the segmental scoliosis at last follow-up. One case with initial kyphosis of 80 degrees continued to progress and required revision anterior and posterior surgery. There were no neurologic complications.
Asunto(s)
Procedimientos Neuroquirúrgicos/instrumentación , Procedimientos Neuroquirúrgicos/métodos , Enfermedad de Scheuermann/cirugía , Columna Vertebral/anomalías , Columna Vertebral/cirugía , Distribución por Edad , Trasplante Óseo/métodos , Preescolar , Femenino , Humanos , Lactante , Fijadores Internos , Masculino , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/etiología , Hemorragia Posoperatoria/prevención & control , Procedimientos de Cirugía Plástica/instrumentación , Procedimientos de Cirugía Plástica/métodos , Estudios Retrospectivos , Enfermedad de Scheuermann/congénito , Enfermedad de Scheuermann/patología , Distribución por Sexo , Fusión Vertebral/instrumentación , Fusión Vertebral/métodos , Columna Vertebral/patología , Resultado del TratamientoRESUMEN
El dorso curvo es una patología frecuente en la infancia y adolescencia, por lo tanto, el pediatra puede verse enfrentado en numerosas oportunidades con el problema. Tanto los padres como los médicos pueden notar la anormalidad y asumir que se trata sólo de un problema postural, restándole la importancia que se merece. La experiencia demuestra que frecuentemente lo que se encuentra bajo este aparente problema postural es una alteración estructural de la columna vertebral, cuyo reconocimiento y tratamientoprecoz permite llegar a resultados satisfactorios sobre la deformidad y sobre las consecuencias uque esta anomalía podría provocar de ser abandonada a su suerte