Abstract
Introduction
Thoracic hyperkyphosis, described as greater than 20 degrees of kyphosis from T1–5, and/or 40 degrees from T5–12, or greater than 50 degrees of maximum total kyphosis, has been associated with poor outcomes when treating EOS. For such patients, decision making between spine based and rib based proximal fixation has been graded as being among the areas of greatest clinical uncertainty at present for surgeons treating EOS. We address this uncertainty by reporting our results of rib based fixation in patients with EOS and thoracic hyperkyphosis. We chose a minimum of 70 degrees of kyphosis between T5–12 for inclusion, rather than 50, to focus further on the management of severe hyperkyphosis.
Material and Methods
Ongoing data collection of surgical management of 13 children with EOS and greater than 20 degrees of kyphosis between T1–5 and/or 70 degrees between T5–12, and at least 24 months of followup was compiled. The (RC) was used for proximal fixation in all cases.
Results
5 syndromic,5 congenital/structural, 1 idiopathic. 9 had prior spine surgery. Average age at initial surgery 84 months; followup averaged 47 months (24–77). 5 had T1–5 kyphosis, average 29 degrees, postop 26. 9 had T5–12 kyphosis, average 96 degrees, postop 56. Average preop thoracic scoliosis 68 postop 44; preop lumbar scoliosis 39, postop 38. Average preop spine length 22.9 cm, postop 29.2. Average preop coronal balance 11.3 cm, postop 13.1. Average preop sagittal balance 39, postop 27. Complications included 3 proximal hook dislodgments, 5 distal anchors, 1 delayed deep wound infection with removal and subsequent replacement of instrumentation, 3 rod failures, 1 PJK. As a group, there were 63 subsequent planned procedures, and 18 unplanned.
Conclusion
The RC provides reliable proximal fixation for EOS patients with severe thoracic hyperkyphosis, especially for those with hyperkyphosis from T5–12.