title: Surgical treatment of cervical kyphosis in Larsen syndrome: report of 3 cases and review of the literature.
abstract: METHODS
  A retrospective case series.
  
  
  OBJECTIVE
  To review the surgical results for midcervical kyphosis in 3 cases with Larsen syndrome, and to discuss the choice of surgical treatments.
  
  
  BACKGROUND
  Cervical kyphosis is the most hazardous and serious manifestation of Larsen syndrome due to the risk of life-threatening paralysis, and thus usually requires surgical treatment. However, little information has been reported concerning surgical treatments for this challenging condition.
  
  
  METHODS
  Three patients with Larsen syndrome were surgically treated for midcervical kyphosis at our institution.
  
  
  RESULTS
  An infant with mild cervical kyphosis was successfully treated with posterior arthrodesis using a halo immobilization, and anterior vertebral growth with a mature posterior fusion mass resulted in spontaneous correction of the kyphosis. In the remaining 2 infants with myelopathic symptoms due to severe and structural kyphosis, anterior decompression and fusion via a lateral approach followed by posterior fusion with segmental spinal instrumentation and halo immobilization resulted in improved neurologic symptoms and solid fusion.
  
  
  CONCLUSIONS
  Posterior spinal fusion is only indicated for patients with mild and flexible cervical kyphosis, and anterior decompression and circumferential arthrodesis is required for patients with severe kyphotic deformity, who usually develop myelopathic symptoms. Anterior surgery for such a small patient with severe kyphosis involves much higher risk of spinal cord injury during decompression maneuvers and difficulty in stabilization of the reconstructed cervical spine. Therefore, all patients with Larsen syndrome should be screened with radiographs at the first visit to detect cervical kyphosis early so that posterior alone fusion is possible.
authors.affiliation: Department of Orthopedics, Osaka University Graduate School of Medicine, Osaka, Japan. sakaurah@ort.med.osaka-u.ac.jp
authors.forename: Hironobu
authors.initials: H
authors.lastname: Sakaura
authors.forename: Takashi
authors.initials: T
authors.lastname: Matsuoka
authors.forename: Motoki
authors.initials: M
authors.lastname: Iwasaki
authors.forename: Kazuo
authors.initials: K
authors.lastname: Yonenobu
authors.forename: Hideki
authors.initials: H
authors.lastname: Yoshikawa
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002675:Child, Preschool; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D006801:Humans; D007223:Infant; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D013577:Syndrome