Severe kyphosis due to congenital dorsal hemivertebra

Correlation between Age and Surgical Approach for Thoracic and Lumbar Hemivertebra

Objective Hemivertebra (HV) is a congenital defect of the formation of the spinal vertebra, which can result in scoliosis or kyphosis along with the related symptomatology of spine deformity. More often than not, it is linked to other abnormalities and requires attention. Its management is surgical and it is of great importance for the physician to choose the right approach at the right time, due to its deteriorative prognosis.

Methods Due to the interest of the subject, the authors investigated the world literature between 1990 and 2018 and found 45 articles, reporting thoracic, thoracolumbar, and lumbar HV in children and its postsurgical outcome, aiming to show whether the approaches are equal in terms of the final outcome.

Results The chosen surgical method depends much on the level of the pathology. Despite this fact, after analyzing the included data, we found that the surgical techniques are unequal with regard to the purpose of achieving improvement. Age, caudal and cranial curves, segmental kyphosis, and scoliosis are factors playing a major role in this.

Conclusion If not treated, HV leads to deterioration and dysfunction. The most optimal result, however, is achieved only when the surgical approach is applied according to age and rest of the accompanying factors, which should be considered in future management planning.

Dorsal midline hemivertebra at the lumbosacral junction: report of 2 cases

Congenital scoliosis from laterally located hemivertebrae at the lumbosacral junction has been described previously. However, dorsally located midline hemivertebrae at this location have not been reported. The authors describe the presentation, treatment, and outcomes of 2 patients (1 male and 1 female) with this rare malformation. All clinical and radiographic records were reviewed. Outcomes were recorded using survey instruments (Oswestry Disability Index and the 36-Item Short Form Health Survey). Radiographic assessment of bony fusion was performed using CT scanning 1 year after surgery. Both patients presented with back and leg pain, urinary hesitancy/incontinence, difficulty sitting and lying down, waddling gait, and restriction of movement. Imaging showed a wedge-shaped dorsal deformity that stretched the nerve roots and compressed the canal. Both patients underwent resection of the hemivertebra with posterolateral instrumented fusion from L-2 to the pelvis. The female patient had a low-lying conus and underwent sectioning of the filum terminale. Both patients showed improvement in the ability to sit and lie flat and in bowel and bladder function after surgery. The authors describe their experience with 2 patients with similar, rare congenital bony deformities at the lumbosacral junction. To their knowledge, similar cases have not been previously reported.

Infantile kyphosis secondary to lumbar hypoplasia: six cases with excessive upright sleeping as a possible cause

Abnormal thoracolumbar kyphosis in infants may be due to lumbar hypoplasia that resolves with development of upright posture. The cause of this deformity has not been previously identified. The goal of this study was to find whether excessive time in an upright posture while sleeping and sitting may play a role in the etiology of infantile thoracolumbar kyphosis. We retrospectively reviewed infants with the diagnosis of kyphosis from 2001 to 2005. Inclusion criteria were patients diagnosed prior to age 3 years without syndromic, neuromuscular, or congenital kyphosis and minimum 2-year follow-up. Serial radiographic evaluation was used to assess change in kyphotic deformity. Six infants with an average age of 7 months at the time of diagnosis were identified. All had marked thoracolumbar kyphosis with vertebral wedging and scalloping. Some had pseudosubluxation at the T12-L1 level. The initial average Cobb angle was 30° (normal, 0°-5°). Careful history revealed that all patients slept in an upright posture in addition to sitting while awake. All of the patients were observed following parental instruction in proper sleeping and sitting habits. At last follow-up, all patients had normal sagittal alignment with an average Cobb angle of 1.3°. Proper sleeping and sitting habits with good spine support is recommended for infantile thoracolumbar kyphosis with lumbar hypoplasia. Allowing "tummy time" during waking hours may help the paraspinal muscles gain strength to provide support to the spine. Radiographic evidence of vertebral body height restoration may be delayed for several years.

Mechanical comparative analysis of three different types of sutures in different dimensions tendons - experimental study

The authors present sixteen patients with congenital kyphosis treated by posterior spinal arthrodesis. A homologous or autogenous iliac bone graft was used. The patients walked with Risser-Cotrel body cast in the 6 months of postoperatory period. The mean time of follow-up was 58,25 months and the mean age of the patients at time of surgery was 9,3 years. The mean angular value of the congenital kyphosis before surgery was 50,44º Cobb and after ther surgery it was 46,94º Cobb. One of the patients who had curve of 69º Cobb, presented pseudoarthrosis. The final results were good in 10, regular in 4 and bad in 2 patients. The need of the diagnostic and precocious treatment is recommended by authors.

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

Vertebral body aplasia or hypoplasia leads to rapidly progressive spinal deformity and neurologic defects when unrecognized in infancy. Four patients with this unusual defect are described.