Anterior instrumentation through posterior approach in neglected congenital kyphosis: a novel technique and case series

Abstract

Purpose: To present a novel technique for anterior instrumentation and reconstruction with PVCR for treatment of severe neglected congenital kyphosis through posterior approach.

Methods: Between 2010 and 2014, all patients with severe congenital kyphosis more than 90° were included. PVCR augmented with anterior vertebral body instrumentation was done for all patients through the same posterior approach. Cobb angle of the main kyphosis and scoliosis curves, the global sagittal and coronal balance were measured preoperatively, postoperatively and at 2-year follow-up. The functional outcome was assessed using the SRS-22 questionnaire preoperatively and at 2-year follow-up.

Results: Fourteen patients with mean age of 19.4 years were included. The mean follow-up period was 38 months. The mean number of resected vertebrae was 2.4 vertebrae per patient. The mean height of the anterior defect after resection was 6.4 cm. The mean preoperative local kyphosis angle was 104.6° that was corrected to a mean of 22.8° at 2-year follow-up. The sagittal vertical axis improved from 62.7 mm preoperatively to 21.4 mm at 2-year follow-up. The mean coronal Cobb angle was 71.2° preoperatively and 25.6° at 2-years follow-up. The mean coronal balance was 32.4 mm preoperatively and 13.6 mm at 2-year follow-up. All patients had significant improvement of the SRS-22 questionnaire at the last follow-up.

Conclusion: Addition of anterior instrumentation to PVCR allows controlled gradual correction and more biomechanical stability. This technique should be preserved for high degrees of sagittal plane deformities. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Anterior instrumentation; Congenital kyphosis; Posterior approach; Posterior vertebral column resection; Severe kyphosis.