Kyphosis of the thoracic and thoracolumbar spine in the pediatric patient: prevention and treatment of surgical complications.
The successful outcome of surgical treatment of pediatric kyphosis depends on careful preoperative identification of the etiology of the problem as well as identification of any associated medical conditions or syndromes that may render surgical reconstruction more challenging. Many perioperative surgical factors can lead to an unsuccessful surgical outcome, including inadequate preoperative patient or kyphosis assessment; inappropriate selection of proximal and/or distal instrumentation and fusion levels; inadequate spinal fixation applied at the ends of the posterior construct where tension forces are greatest; inadequate performance of a meticulous posterior spinal fusion; absence and/or an inadequate performance of an anterior spinal fusion when required either before or after the posterior procedure; overcorrection of the kyphotic deformity based on the ability of the spine above and below to compensate for the correction; a higher risk of neurologic complications with correction of kyphotic deformities; and inadequate postoperative support with an orthosis. Revision surgery for failed pediatric kyphosis surgeries requires careful reexamination of all these factors to correct any shortcomings. In addition, adjunctive procedures such as spinal osteotomies, perioperative traction, and/or anterior fusion techniques may be required to optimize spinal alignment, balance, and ultimate successful fusion. When following these guidelines, pediatric spinal kyphosis disorders can be successfully treated and complications avoided.
Lenke
Lawrence G
LG
Washington University School of Medicine, St. Louis, Missouri, USA.
D000293:Adolescent; D002648:Child; D006801:Humans; D007738:Kyphosis / Q000601:surgery*; D010027:Osteotomy / Q000379:methods; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D012086:Reoperation; D013123:Spinal Fusion; D013904:Thoracic Vertebrae; D014143:Traction / Q000379:methods; D017211:Treatment Failure