Clinical, radiological, and functional outcomes of posterior-only three-column osteotomy in congenital kyphosis

Aims To describe the clinical, radiological, and functional outcomes in patients with isolated congenital thoracolumbar kyphosis who were treated with three-column osteotomy by posterior-only approach. Methods Hospital records of 27 patients with isolated congenital thoracolumbar kyphosis undergoing surgery at a single centre were retrospectively analyzed. All patients underwent deformity correction which involved a three-column osteotomy by single-stage posterior-only approach. Radiological parameters (local kyphosis angle (KA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), C7 sagittal vertical axis (C7 SVA), T1 slope, and pelvic incidence minus lumbar lordosis (PI-LL)), functional scores, and clinical details of complications were recorded. Results The mean age of the study population was 13.9 years (SD 6.4). The apex of deformity was in thoracic, thoracolumbar, and lumbar spine in five, 14, and eight patients, respectively. The mean operating time was 178.4 minutes (SD 38.5) and the mean operative blood loss was 701.8 ml (SD 194.4). KA (preoperative mean 70.8° (SD 21.6°) vs final follow-up mean 24.7° (SD 18.9°); p < 0.001) and TK (preoperative mean -1.48° (SD 41.23°) vs final follow-up mean 24.28° (SD 17.29°); p = 0.005) underwent a significant change with surgery. Mean Scoliosis Research Society (SRS-22r) score improved after surgical correction (preoperative mean 3.24 (SD 0.37) vs final follow-up mean 4.28 (SD 0.47); p < 0.001) with maximum improvement in self-image and mental health domains. The overall complication rate was 26%, including two neurological and five non-neurological complications. Permanent neurological deficit was noted in one patient. Conclusion Deformity correction employing three-column osteotomies by a single-stage posterior-only approach is safe and effective in treating isolated congenital thoracolumbar kyphosis. Cite this article: Bone Joint J 2021;103-B(7):1309–1316.

Beneficial Effects of Surgical Treatment of Compressive Myelopathy in Patients With Severe Angular Kyphosis of Thoracolumbar Spine: A Retrospective Study of 12 Cases

Background: Severe angular kyphosis is one of the uncommon etiologies of compressive myelopathy and hence, many aspects of this myelopathy are unknown. Objectives: In this study, we report a series of 12 patients with compressive myelopathy in severe angular kyphosis, as well as the result of surgical treatment in these patients. Methods: In a retrospective study, we included 12 patients with the progressive or sudden onset of paraplegia caused by severe angular kyphosis. The neurological status of the patients was evaluated with the American Spinal Injury Association (ASIA) typing system before the operation and at four time points after the operation (1 day, 1 week, 6 months, 1 year). The main surgical interventions included anterior corpectomy, anterior spinal fusion, and posterior spinal fusion with or without instrumentation and with or without decompression. Results: The Mean±SD age of the patients was 41.9±16.4 years, ranging from 14 to 59 years. The etiology of myelopathy was congenital kyphosis in 10 patients (83.3%). The Mean±SD duration of paralysis was 6.4±6.6 months. The Mean±SD percentage of cord thinning at the apex was 61.7±17.5%. Bowel or bladder dysfunction was present in 6 patients (50%) before the surgery that was resolved in 5 patients after the surgery. One year after the surgery, the ASIA typing was improved in 9 patients (75%) and remained the same as preoperative status in 3 patients (25%). Conclusion: Surgical decompression corrects the neurological symptoms in the majority of cases with compressive myelopathy caused by severe angular kyphosis.