Congenital kyphosis and subluxation of the thoraco-lumbar spine due to vertebral aplasia

Wedge Hemivertebra Forward-Shifting Technique for Treatment of Congenital Kyphosis: Case Report, Technical Note, and Literature Review

BACKGROUND

Congenital kyphosis due to wedge hemivertebra is an uncommon spinal deformity that could progressively develop into sagittal imbalance accompanied by subsequent neurologic deterioration if no intervention is performed. Numerous surgical techniques have been reported, since congenital kyphosis has shown no response to conservative treatments. Currently, osteotomy procedures, which are considered technically demanding and risky, have become the mainstream techniques for the correction of congenital kyphosis.

METHODS

We describe the use of a novel surgical procedure combining forward-shifting of anterior column of the wedge hemivertebra and circumferential fusion for treatment of congenital kyphosis secondary to a wedge hemivertebra in a case of a 13-year-old boy who showed a 49° angular kyphosis from T12 to L2 secondary to a wedge hemivertebra in L1.

RESULTS

The focal kyphosis was corrected to 5° with a correction rate of 89.8% after operation, and the sagittal balance was significantly preserved with no complication. Solid fusion was detected at the final follow-up.

CONCLUSIONS

This novel procedure, combining forward-shifting of anterior column of the wedge hemivertebra and circumferential fusion, is a feasible, effective, and safe technique for the treatment of some special type 1 congenital kyphosis cases, with a high correction rate and no major complications.

Segmental spinal dysgenesis associated with occult dysraphism: Considerations on management strategies

Segmental spinal dysgenesis is a rare and challenging entity especially when associated with occult dysraphism. Experience with a female patient followed during a period of 10 years spanning from 5 to 15 years of age is reported. During that period the girl underwent three spinal operations consisting in one decompression and spinal cord untethering, one posterior instrumented fusion and a spinal cord re-untethering. Clinical and radiological features are discussed and considerations on optimization of management strategies are made.

Surgical treatment of congenital thoracolumbar spondyloptosis in a 2-year-old child with vertebral column resection and posterior-only circumferential reconstruction of the spine column: case report

Spondyloptosis refers to complete dislocation of a vertebral body onto another. The L5-S1 level is frequently affected. As this condition is rare, few published reports describing its clinical features and surgical outcomes exist, especially in the pediatric patient population. The authors report the presentation, pathological findings, and radiographic studies of a 2-year-old girl who presented to Texas Children's Hospital with a history since birth of progressive spastic paraparesis. Preoperative CT and MRI showed severe spinal cord compression associated with T11-12 spondyloptosis. The patient underwent a single-stage posterior approach for complete resection of the dysplastic vertebral bodies at the apex of the spinal deformity with reconstruction and stabilization of the vertebral column using a titanium expandable cage and pedicle screws. At the 12-month follow-up, the patient remained neurologically stable without any radiographic evidence of instrumentation failure or loss of alignment. To the best of the authors' knowledge, there have been only 2 other children with congenital thoracolumbar spondyloptosis treated with the above-described strategy. The authors describe their case and review the literature to discuss the aggregate clinical features, surgical strategies, and operative outcomes for congenital thoracolumbar spondyloptosis.

Congenital dislocated spine: implications for orthopaedic management

BACKGROUND

Congenital dislocation of the spine (CDS) is a rare malformation due to a developmental failure of the spine and the spinal cord at a single spinal level. New embryological and physiopathological findings define CDS as an autonomous entity compared with multilevel pathologies. The severity of CDS neurological outcome requires its treatment by experienced pediatric spine surgeons in a pediatric specialty hospital. This report aims to propose a comprehensive orthopaedic management strategy and operative technique of CDS in 6 new patients.

METHODS

The records of patients treated at our institution for congenital anomalies of the spine were reviewed in a retrospective study. Inclusion criteria were extracted from the actual context of new embryologic theories: single level involvement; sudden mainly sagittal vertebral displacement with anterior translation of the entire cranial vertebral column on the caudal vertebrae ("step-off sign"); underlying spinal malformation at a clearly distinct level; spinal cord intact both cranial and caudal to the malformation; possibility of malformed aspect of the 2 involved vertebrae. Demographic data, family, and clinical history were collected. Complete set of plain radiographs and modern imaging computed tomography and magnetic resonance imaging were analyzed.

RESULTS

Six children treated between 1993 and 2007 have been classified as CDS. The mean follow-up to date of the 4 patients alive after the last corrective surgery is 9.8 years (range, 1-14.6 years). All patients alive have at follow-up solid stable fusion and no progression of spinal deformity. Two of the patients are independent walkers.

CONCLUSIONS

The neurological involvement of CDS if present initially is the consequence of an associated spinal cord malformation without mechanical factor. Adaptation of the therapeutic strategy may avoid secondary neurological damage. Parents should be counseled as soon as the diagnosis is made, the obstetrical and postnatal orthopaedic management has to be adapted. Stabilization of the spine including very early cast immobilization and an early instrumented decompression-stabilization with circumferential fusion in 1 stage is required.

Lumbar agenesis with sacral sparing: a case report

Caudal agenesis or caudal regression syndrome refers to a spectrum of malformations involving the lower spine, which can result in significant progressive or permanent neurologic defects. Caudal agenesis is frequently associated with other congenital anomalies of the axillary skeleton, hindgut and genitourinary systems. Described in this paper is a patient who presented with multiple clinical and radiographic findings consistent with caudal agenesis. This case is unique in that there is total absence of the lumbar vertebral column with an intact spinal cord and bony sacrum.

Segmental spinal dysgenesis. A disorder different from spinal agenesis

We reviewed the clinical and roentgenographic findings, treatment, and results for seventeen patients (six male and eleven female) who had segmental spinal dysgenesis, a disorder frequently confused with, but distinct from, lumbar and lumbosacral agenesis. The average age at the time of presentation to the Minnesota Spine Center or the Gillette Children's Hospital was two and a half years (range, newborn to twenty-one years), and the average duration of follow-up was eight years (range, five months to twenty-two years). At the time of the diagnosis, eight patients had neurological deficits: seven had a neurogenic bladder and four had weakness of the lower extremities. An average of 2.6 procedures (range, one to five procedures) was needed to obtain a solid fusion. Decompression of the stenotic canal was performed in ten patients, and it was followed by an improvement in neurological function in two of them. A solid fusion of the spine, arrest of the progressive kyphosis, and stabilization of neurological function were obtained in all patients. We recommend early anterior and posterior arthrodesis in patients who have segmental spinal dysgenesis, as the progressive kyphosis that inevitably develops often results in neurological deficits.