| PEDIATRIC CERVICAL KYPHOSIS: A COMPARISON OF ARTHRODESIS TECHNIQUES. | |
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MedLine Citation:
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PMID: 21343865 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Study Design: Retrospective study.Objective: To compare arthrodesis techniques for pediatric cervical kyphosis.Summary of Background Data: Cervical kyphosis is rare in the pediatric population. The most common etiologies are acquired instability or an underlying syndrome. The largest pediatric case series in the literature describes the treatment of nine patients.Methods: A retrospective review was performed of pediatric patients treated for cervical kyphosis with posterior spinal fusion (PSF), anterior spinal fusion with strut graft (ASF), or circumferential fusion with strut graft (A/PSF). Patients were divided into groups based upon the etiology of the kyphosis. Group 1 was acquired instability, either traumatic or post-laminectomy. Group 2 was syndromic deformity.Results: 24 patients were identified; 9 in Group 1 and 15 in Group 2. Arthrodesis techniques: Group 1 = 2 PSF, 2 ASF, 5 A/PSF, Group 2 = 11 PSF, 0 ASF, 4 A/PSF. Primary union was achieved in all Group 1 patients with no major complications. Pseudarthrosis and other major complications were frequent in Group 2. Among syndromic patients (Group 2) treated with primary PSF (11 patients), the mean immediate postoperative kyphosis was 32° in 7 patients that achieved primary union and 77° in 4 patients with pseudarthrosis requiring reoperation (p = 0.022); 2 of these 4 patients with pseudarthrosis developed late myelopathy with an episode of transient quadriparesis. Primary union was achieved in 3 of 4 syndromic patients with A/PSF; pseudarthrosis occurred in the patient with Gorham's disease.Conclusion: Arthrodesis was effective without major complications in non-syndromic kyphosis. Complications were frequent in syndromic kyphosis. There was a significant association of greater residual kyphosis with pseudarthrosis in syndromic patients treated with PSF alone. Circumferential arthrodesis with strut grafting may decrease pseudarthrosis risk in syndromic patients with severe, rigid kyphosis. PSF alone may be sufficient in syndromic patients with flexible kyphosis when adequate postoperative correction is achieved. |
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Authors:
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Jeffrey E Martus; Terri E Griffith; J Cuyler Dear; Karl E Rathjen |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-2-18 |
Journal Detail:
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Title: Spine Volume: - ISSN: 1528-1159 ISO Abbreviation: - Publication Date: 2011 Feb |
Date Detail:
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Created Date: 2011-2-23 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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1Department of Orthopaedics and Rehabilitation, Vanderbilt Children's Hospital, 2200 Children's Way, 4202 DOT, Nashville, TN 37232-9565, 615-343-5875 (phone), 615-343-2423 (fax), jeff.martus@vanderbilt.edu 2University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas, TX, 75390 3Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219. |
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