Surgical treatment of severe angular kyphosis with myelopathy: anterior and posterior approach with pedicle screw instrumentation.
METHODS
Retrospective study.


OBJECTIVE
To evaluate the outcomes of anterior decompression and fusion followed by posterior instrumented fusion using pedicle screws without intentional correction of severe angular kyphosis deformity with myelopathy.


BACKGROUND
Treatment of severe angular kyphosis with myelopathy is extremely difficult and dangerous. Although surgical circumferential spinal osteotomy via a single posterior approach has been reported in several studies, serious neurologic complications are a possible outcome.


METHODS
Among 51 patients surgically treated for angular kyphosis from 1988 to 2004, 16 patients (follow-up period, 32-168 months; mean, 72 months) with severe (>70 degrees ) angular kyphosis with progressive myelopathic symptoms underwent anterior decompression and fusion, followed by posterior pedicle screw instrumentation and bone graft without attempted correction of the deformity. Radiologic assessment, clinical findings including pain and daily activity scores, and neurologic status using the modified Frankel grade were analyzed before surgery and at the last follow-up.


RESULTS
Curve progression or nonunion did not occur in any of the cases. The mean pain and daily activity score were 3.1 and 2.3 before surgery and 4.7 and 4.2 after surgery, respectively. The modified Frankel grade indicated that every patient but one had improved neurologic function by one or more grades. Nine (75%) of 12 patients with ankle clonus, 10 (71%) of 14 patients with Babinski sign, and 6 (55%) of 11 patients with bowel and bladder dysfunction showed full improvement at the last follow-up. Postoperative complications included 1 screw pullout case and 2 infection cases which resolved without incidence.


CONCLUSIONS
Anterior decompression and fusion followed by posterior pedicle screw instrumentation and fusion without correction effectively improved neurologic symptoms and halted progression of kyphotic deformity in cases of severe angular kyphosis with myelopathy.
Song
Kwang-Sup
KS
Department of Orthopedic Surgery, Chung-Ang University, Seoul, Korea.
Chang
Bong-Soon
BS
Yeom
Jin Sup
JS
Lee
Jae Hyup
JH
Park
Kun-Woo
KW
Lee
Choon-Ki
CK
D000293:Adolescent; D000328:Adult; D001863:Bone Screws; D002648:Child; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000295:instrumentation / Q000379:methods; D012189:Retrospective Studies; D013118:Spinal Cord Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*