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Pediatric Cervical Kyphosis: A Comparison of Arthrodesis Techniques

Martus, Jeffrey E., MD*; Griffith, Terri E., BS; Dear, J. Cuyler, BBA; Rathjen, Karl E., MD

doi: 10.1097/BRS.0b013e3182039844
Cervical Spine
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Study Design. Retrospective study.

Objective. To compare arthrodesis techniques for pediatric cervical kyphosis.

Summary of Background Data. Cervical kyphosis is rare in the pediatric population. The most common etiologies are acquired instabilities or an underlying syndrome. The largest pediatric case series in the literature describes the treatment of nine patients.

Methods. A retrospective review was performed of pediatric patients treated for cervical kyphosis with posterior spinal fusion (PSF), anterior spinal fusion (ASF) with strut graft, or anteroposterior fusion with strut graft (A/PSF). Patients were divided into groups on the basis of the etiology of the kyphosis. Group 1 was composed of patients with acquired instability, either traumatic or postlaminectomy. Group 2 was composed of patients with syndromic deformity.

Results. Twenty-four patients were identified: 9 in group 1 and 15 in group 2. Arthrodesis techniques performed in group 1 were 2 PSF, 2 ASF, and 5 A/PSF and in group 2 were 11 PSF, 0 ASF, and 4 A/PSF. Primary union was achieved in all group 1 patients with no major complications. Pseudarthrosis and other major complications were frequent in group 2. Among syndromic patients (group 2) treated with primary PSF (11 patients), the mean immediate postoperative kyphosis was 32° in seven patients who achieved primary union and 77° in four patients with pseudarthrosis who required reoperation (P = 0.022); two of these four patients with pseudarthrosis developed late myelopathy with an episode of transient quadriparesis. Primary union was achieved in three of four syndromic patients with A/PSF; pseudarthrosis occurred in the patient with Gorham's disease.

Conclusion. Arthrodesis was effective without major complications in nonsyndromic kyphosis. Complications were frequent in syndromic kyphosis. There was a significant association of greater residual kyphosis with pseudarthrosis in syndromic patients treated with PSF alone. Circumferential arthrodesis with strut grafting may decrease pseudarthrosis risk in syndromic patients with severe, rigid kyphosis. PSF alone may be sufficient in syndromic patients with flexible kyphosis when adequate postoperative correction is achieved.

Arthrodesis techniques were retrospectively compared for pediatric cervical kyphosis. Complications, pseudarthrosis, and late myelopathy were more common among syndromic patients. Among syndromic patients, greater residual kyphosis after posterior fusion was significantly associated with pseudarthrosis; posterior fusion may be sufficient in flexible kyphosis, while circumferential arthrodesis may decrease the risk of pseudarthrosis for severe, rigid kyphosis.

* Department of Orthopaedics and Rehabilitation, Vanderbilt Children's Hospital, Nashville, Tennessee

University of Texas Southwestern Medical School, Dallas

Department of Orthopaedic Surgery, Texas Scottish Rite Hospital for Children, Dallas.

Address correspondence and reprint requests to Jeffrey E. Martus, MD, Department of Orthopaedics and Rehabilitation, Vanderbilt Children's Hospital, 2200 Children's Way, 4202 DOT, Nashville, TN 37232; E-mail: jeff.martus@vanderbilt.edu

Acknowledgment date: March 30, 2010. Revision date: September 28, 2010. Acceptance date: October 23, 2010.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2011 Lippincott Williams & Wilkins, Inc.