Childhood angular kyphosis: a plea for involvement of the pediatric neurosurgeon.
BACKGROUND
Childhood angular kyphosis is rare, as most children are affected by a mixed kyphotic and scoliotic deformity. Published series involving a mix of kyphosis and kyphoscoliosis, pediatric and adult, congenital and acquired cases are almost exclusively authored by orthopedic surgeons, suggesting that (pediatric) neurosurgeons are not involved.


METHODS
We present five cases that illustrate the spectrum of angular kyphosis, and these were treated by a multidisciplinary team including child neurologist, orthopedic surgeon, and pediatric neurosurgeon as complementary partners.


CONCLUSIONS
Angular kyphosis is a cosmetic problem but above all a serious threat to the spinal cord and as such to the child's ambulatory, sphincter, and genito-urinary functions. Spinal cord stretch over the internal kyphosis may cause pain and/or neurological deficit, often accompanied by myelomalacia or even segmental cord atrophy. Spinal cord function may be additionally affected by associated disorders such as syringomyelia or tethered cord, an orthopedic surgeon may be less familiar with. The decision when and how to proceed surgically should be made by a multidisciplinary team, including a pediatric neurosurgeon who actively participates in the operation and helps to safely achieve adequate spinal cord decompression and stabilization.


CONCLUSIONS
Childhood angular kyphosis is a complex, heterogeneous disorder that should be managed by a multidisciplinary team in specialized pediatric spine centers. While every case is truly unique, the spinal cord is always at risk, especially during decompression, stabilization, and eventual correction of deformity. Pediatric neurosurgeons have an important role to play in preoperative work-up, actual operation, and follow-up.
Department of Neurosurgery, Maastricht University Medical Center, Oxfordlaan 10, 6229 EV, Maastricht, The Netherlands. e.cornips@mumc.nl.
E
http://orcid.org/0000-0002-5718-1696
E
Cornips
Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
S
S
Koudijs
Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
J
J
Vles
Department of Orthopedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
L
L
van Rhijn
D000293:Adolescent; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D000069471:Neurosurgeons; D019635:Neurosurgical Procedures / Q000379:methods*; D010819:Physician's Role; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery
Case management; Child; Kyphosis; Neurosurgeon