Spinal deformity after intra-operative radiotherapy for paediatric patients

Treatment of Kyphosis Arising Secondary to Laminectomy and Irradiation in the Pediatric Population

The effects of radiation therapy and laminectomy on the growing spine have been well documented. Due to compromised bone quality after irradiation, spinal fusion has a high failure rate. The aim of this study was to evaluate treatment of post-laminectomy and post-irradiation kyphosis in children using a vascularized rib graft (VRG) to augment anterior spinal fusion and posterior spinal fusion. Data were collected retrospectively from electronic medical records for all patients treated at a single institution for post-laminectomy and post-irradiation kyphosis who underwent VRG to augment spinal fusions done between December 2003 and August 2015. Five patients were included in the analysis. Imaging studies were analyzed by 2 senior pediatric orthopedic surgeons and a pediatric orthopedic surgery fellow. The outcome for all 5 patients who underwent VRG were considered successful at most recent clinical follow-up. Success was defined as the following: complete fusion evident through computed tomography scan, no implant failure, and no kyphosis progression. Follow-up ranged from 21 to 63 months. One patient experienced 2 complications: esophageal tear and deep infection. Spinal fusion with a VRG is a viable treatment option for children who have developed kyphosis following laminectomy and irradiation. On long-term follow-up, there has been no evidence of progression of kyphosis for patients who were treated with VRG in either the primary fusion procedure or in subsequent revision procedures. A VRG provides a non-irradiated, vascularized bone graft to bridge the irradiated segments, increasing the stability of the spine. [Orthopedics. 2021;44(4):e563-e569.].

Round and angular kyphosis in paediatric patients

Structural kyphosis is a posterior convex deformity of the spine that may appear in childhood then worsen with growth, most notably during the pubertal growth spurt. The abnormal curvature may be smooth, defining round kyphosis, or may display a sharp angular pattern. Angular kyphosis is the more severe of the two forms. The main causes of round kyphosis are postural kyphosis and Scheuermann's disease. The spontaneous outcome is favourable, and round kyphosis is well tolerated in adulthood. The treatment relies on orthopaedic methods in the overwhelming majority of cases. Surgery is reserved for severe rigid kyphosis in older children and for kyphosis responsible for refractory pain or neurological deficits. Surgical treatment carries a non-negligible risk of neurological, gastrointestinal, mechanical, and septic complications, which should be explained clearly to the family. Advances in contemporary posterior instrumentation have considerably limited the indications for anterior approaches. Many conditions may cause angular kyphosis, whose greater severity is related to a greater potential for progression and neurological impairment. Clinical investigations are in order to identify the cause and to plan the surgical strategy. Early surgery may be indicated, via a combined anterior and posterior approach. Anterior strut grafting, anterior or posterior osteotomies, or even vertebral column resections may be necessary to correct a major deformity.