Cornips E, Koudijs S, Vles J, van Rhijn L
Department of Neurosurgery, Maastricht University Medical Center, Oxfordlaan 10, 6229 EV, Maastricht, The Netherlands.
Department of Child Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.
Childs Nerv Syst. 2017 Jun;33(6):973-981. doi: 10.1007/s00381-017-3389-y. Epub 2017 Mar 25.
Childhood angular kyphosis is rare, as most children are affected by a mixed kyphotic and scoliotic deformity. Published series involving a mix of kyphosis and kyphoscoliosis, pediatric and adult, congenital and acquired cases are almost exclusively authored by orthopedic surgeons, suggesting that (pediatric) neurosurgeons are not involved.
We present five cases that illustrate the spectrum of angular kyphosis, and these were treated by a multidisciplinary team including child neurologist, orthopedic surgeon, and pediatric neurosurgeon as complementary partners.
Angular kyphosis is a cosmetic problem but above all a serious threat to the spinal cord and as such to the child's ambulatory, sphincter, and genito-urinary functions. Spinal cord stretch over the internal kyphosis may cause pain and/or neurological deficit, often accompanied by myelomalacia or even segmental cord atrophy. Spinal cord function may be additionally affected by associated disorders such as syringomyelia or tethered cord, an orthopedic surgeon may be less familiar with. The decision when and how to proceed surgically should be made by a multidisciplinary team, including a pediatric neurosurgeon who actively participates in the operation and helps to safely achieve adequate spinal cord decompression and stabilization.
Childhood angular kyphosis is a complex, heterogeneous disorder that should be managed by a multidisciplinary team in specialized pediatric spine centers. While every case is truly unique, the spinal cord is always at risk, especially during decompression, stabilization, and eventual correction of deformity. Pediatric neurosurgeons have an important role to play in preoperative work-up, actual operation, and follow-up.
儿童角状后凸畸形较为罕见，因为大多数儿童受混合性后凸和脊柱侧凸畸形影响。已发表的系列研究涉及后凸畸形和脊柱后凸侧凸畸形、儿童和成人、先天性和后天性病例，几乎均由骨科医生撰写，这表明（儿科）神经外科医生未参与其中。
我们呈现了5例病例，展示了角状后凸畸形的范围，这些病例由包括儿童神经科医生、骨科医生和儿科神经外科医生在内的多学科团队作为互补伙伴进行治疗。
角状后凸畸形不仅是一个外观问题，更是对脊髓的严重威胁，进而影响儿童的行走、括约肌及泌尿生殖功能。脊髓在内在后凸畸形处的拉伸可能导致疼痛和/或神经功能缺损，常伴有脊髓软化甚至节段性脊髓萎缩。脊髓功能可能还会受到诸如脊髓空洞症或脊髓栓系等相关疾病的影响，而骨科医生可能对此不太熟悉。手术时机和方式的决策应由多学科团队做出，其中包括积极参与手术并有助于安全实现充分脊髓减压和稳定的儿科神经外科医生。
儿童角状后凸畸形是一种复杂的异质性疾病，应由专业儿科脊柱中心的多学科团队进行管理。虽然每个病例都独一无二，但脊髓始终面临风险，尤其是在减压、稳定及最终矫正畸形过程中。儿科神经外科医生在术前评估、实际手术及随访中发挥着重要作用。
