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.