Surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population.

IF 1.6 Q3 CLINICAL NEUROLOGY

Spine deformity Pub Date : 2024-10-21 DOI:10.1007/s43390-024-00986-w

Julián Calcagni, Carlos A Tello, Lucas Piantoni, Rodrigo Remondino, Eduardo Galaretto, Juan Pablo Arispe, Mariano Noel

{"title":"Surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population.","authors":"Julián Calcagni, Carlos A Tello, Lucas Piantoni, Rodrigo Remondino, Eduardo Galaretto, Juan Pablo Arispe, Mariano Noel","doi":"10.1007/s43390-024-00986-w","DOIUrl":null,"url":null,"abstract":"Purpose: There is no standardized and universally accepted surgical treatment for thoracic and lumbar hyperkyphosis in children. A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique.Methods: A retrospective analysis was conducted of patients younger than 18 years who underwent primary correction surgery and posterior fusion for thoracic and lumbar hyperkyphosis. Patients were categorized according to the classification of Rajasekaran et al. and divided into 2 groups: a posterior column osteotomies (PCO) group and a three-column osteotomies (3CO) group. We analyzed the angularity and flexibility of the curve, global sagittal balance, and preoperative neurological status of the patient.Results: Forty-nine patients were included. The mean age was 12.8 years (1-18) and the mean preoperative kyphosis was 93.5° (40°-175°). In the PCO group (N = 30), the sagittal deformity angular ratio (DAR) was less than 16.5 in 26 patients (86.6%), while in the 3CO group (N = 19), sagittal DAR was greater than 16.5 in 17 patients (89.4%). In the PCO group (N = 28), the T1-Pelvic angle (TPA) was less than 17° in 19 patients (67.8%), while in the 3CO group (N = 15), TPA was greater than 17° in 10 patients (66.6%). Five patients (10.2%) had recent-onset or progressive neurological alteration, all of them (100%) required 3CO.Conclusion: An algorithm for kyphosis was developed based on the classification by Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance and neurological status of the patient, to aid in the choice of the appropriate corrective osteotomy.Level of evidence: IV.","PeriodicalId":21796,"journal":{"name":"Spine deformity","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2024-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Spine deformity","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s43390-024-00986-w","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose: There is no standardized and universally accepted surgical treatment for thoracic and lumbar hyperkyphosis in children. A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique.

Methods: A retrospective analysis was conducted of patients younger than 18 years who underwent primary correction surgery and posterior fusion for thoracic and lumbar hyperkyphosis. Patients were categorized according to the classification of Rajasekaran et al. and divided into 2 groups: a posterior column osteotomies (PCO) group and a three-column osteotomies (3CO) group. We analyzed the angularity and flexibility of the curve, global sagittal balance, and preoperative neurological status of the patient.

Results: Forty-nine patients were included. The mean age was 12.8 years (1-18) and the mean preoperative kyphosis was 93.5° (40°-175°). In the PCO group (N = 30), the sagittal deformity angular ratio (DAR) was less than 16.5 in 26 patients (86.6%), while in the 3CO group (N = 19), sagittal DAR was greater than 16.5 in 17 patients (89.4%). In the PCO group (N = 28), the T1-Pelvic angle (TPA) was less than 17° in 19 patients (67.8%), while in the 3CO group (N = 15), TPA was greater than 17° in 10 patients (66.6%). Five patients (10.2%) had recent-onset or progressive neurological alteration, all of them (100%) required 3CO.

Conclusion: An algorithm for kyphosis was developed based on the classification by Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance and neurological status of the patient, to aid in the choice of the appropriate corrective osteotomy.

Level of evidence: IV.

查看原文本刊更多论文

小儿胸椎和腰椎过度突出症的手术治疗算法。

目的：对于儿童胸椎和腰椎骨盆下垂症，目前还没有标准化和普遍接受的手术治疗方法。方法：对接受初次矫正手术的 18 岁以下患者进行了回顾性分析：方法：我们对因胸椎和腰椎后凸畸形而接受初次矫正手术和后路融合术的 18 岁以下患者进行了回顾性分析。根据 Rajasekaran 等人的分类方法将患者分为两组：后柱截骨术（PCO）组和三柱截骨术（3CO）组。我们分析了患者曲线的角度和柔韧性、整体矢状面平衡以及术前神经状态：结果：共纳入 49 名患者。平均年龄为 12.8 岁（1-18 岁），术前平均椎体后凸为 93.5°（40°-175°）。在 PCO 组（30 人）中，26 名患者（86.6%）的矢状位畸形角度比（DAR）小于 16.5，而在 3CO 组（19 人）中，17 名患者（89.4%）的矢状位畸形角度比大于 16.5。在 PCO 组（28 人）中，19 名患者（67.8%）的 T1 盆角（TPA）小于 17°，而在 3CO 组（15 人）中，10 名患者（66.6%）的 TPA 大于 17°。5名患者（10.2%）近期出现或进行性神经系统改变，所有患者（100%）都需要进行3CO治疗：根据Rajasekaran等人的分类、术前对患者曲线角度和柔韧性、整体矢状面平衡和神经状况的分析，制定了脊柱后凸的算法，以帮助选择合适的矫正截骨术：证据等级：IV。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Spine deformity

CiteScore

3.20

自引率

18.80%

发文量

167

期刊介绍： Spine Deformity the official journal of the?Scoliosis Research Society is a peer-refereed publication to disseminate knowledge on basic science and clinical research into the?etiology?biomechanics?treatment?methods and outcomes of all types of?spinal deformities. The international members of the Editorial Board provide a worldwide perspective for the journal's area of interest.The?journal?will enhance the mission of the Society which is to foster the optimal care of all patients with?spine?deformities worldwide. Articles published in?Spine Deformity?are Medline indexed in PubMed.? The journal publishes original articles in the form of clinical and basic research. Spine Deformity will only publish studies that have institutional review board (IRB) or similar ethics committee approval for human and animal studies and have strictly observed these guidelines. The minimum follow-up period for follow-up clinical studies is 24 months.