Surgical Correction of Fixed Kyphosis

STUDY DESIGN: A retrospective review was carried out on 23 patients with rigid fixed kyphosis who underwent surgical correction for their deformity. PURPOSE: To report the results of surgical correction of fixed kyphosis according to the surgical approaches or methods. OVERVIEW OF LITERATURE: Surgical correction of fixed kyphosis is more dangerous than the correction of any other spinal deformity because of the high incidence of paraplegia. METHODS: There were 12 cases of acute angular kyphosis (6 congenital, 6 healed tuberculosis) and 11 cases of round kyphosis (10 ankylosing spondylitis, 1 Scheuermann's kyphosis). Patients were excluded if their kyphosis was due to active tuberculosis, fractures, or degenerative lumbar changes. Operative procedures consisted of anterior, posterior and combined approaches with or without total vertebrectomy. Anterior procedure only was performed in 2 cases, while posterior procedure only was performed in 8 cases. Combined procedures were used in 13 cases, including 4 total vertebrectomies. RESULTS: The average kyphotic angle was 71.8degrees preoperatively, 31.0degrees postoperatively, and the average final angle was 39.2degrees. Thus, the correction rate was 57% and the correction loss rate was 12%. In acute angular kyphosis, correction rate of an anterior procedure only was 71%, correction rate of the combined procedures without total vertebrectomy was 49% and correction rate of the combined procedures with total vertebrectomy was 60%. In round kyphosis, correction rate of posterior procedure only was 65% and correction rate of combined procedures was 59%. The clinical results according to the Kirkaldy-Willis scale demonstrated 17 excellent outcomes, 5 good outcomes and one poor outcome. CONCLUSIONS: Our data indicates that the combined approach and especially the total vertebrectomy showed the safety and the greatest correction rate if acute angular kyphosis was greater than 60 degrees.

Surgical Correction of Fixed Kyphosis / 대한정형외과학회잡지

Morphologically, kyphosis is devided into two groups, pure kyphosis and kyphoscoliosis, according to whether or not scoiiosis is combined. Or kyphosis can be devided into round kyphosis or angular kyphosis. The examples of round kyphosis are Scheuermanns kyphosis or ankylosing spondylitis. Acute angular kyphosis are of congenital kyphosis or old healed tuberculosis. The purpose of surgical correction of fixed kyphosis is to correct deformity as well as to prevent or to recover from paraplegia. The operation also improve respiratory and digestive function by diminishing compression of abdomen. However, the correction of this deformity is more dangerous in eliciting paraplegia than any other spinal deformity. In considering surgical correction of kyphosis we have to decide which approach is the best for that particular patient at that particular time. Usually majority of patient need combined anterior and posterior approach. The extent of fusion depends upon the flexibility of the kyphosis. Anterior fusion should encompass at least the rigid and inflexible portion of the kyphosis as determined by the hyperextension x-ray of the spine. Posterior fusion should encompass the full extent of the kyphosis. The purpose of this study is to report our results for surgical correction and to find the operative procedure which shows the best result. We hereby report surgically corrected 14 cases of fixed kyphosis who were hospitalized here from April 1988 to February 1995.