Mallepally Abhinandan Reddy, Mahajan Rajat, Marathe Nandan, Nanda Ankur, Rustagi Tarush, Chhabra Harvinder Singh
Indian Spinal Injuries Centre, New Delhi, India.
Asian J Neurosurg. 2021 Feb 23;16(1):106-112. doi: 10.4103/ajns.AJNS_311_20. eCollection 2021 Jan-Mar.
Corrective maneuvers in an angular kyphotic deformity have its own problems including early complications such as neurological deficit and late complications such as proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). This article discusses the probable mechanisms, leading to PJK in pediatric severe angular kyphotic deformities and preventive strategies for the same. We will also assess natural course of untreated PJK and its devastating consequences.
Three patients, two 13-year males presented with progressive, painless thoracolumbar kyphoscoliotic deformity, with segmental kyphosis 100° and 140° and scoliosis of 33° and 78°, respectively, and one 14-year-old female presented with angular kyphotic deformity of 60° with apex at D11-12 level.
Posterior vertebral column resection with segmental deformity correction with good coronal and sagittal balance was done. In the follow-up, PJF was seen. Second surgery was done with the extension of instrumentation to D4 along with deformity correction in both the male patients. The female patient did not opt for a revision surgery, and we are following the natural history of this case.
In severe thoracolumbar angular kyphotic deformities with normal or negative sagittal balance, it might be a safer option to select the sagittal stable vertebra as upper instrumented vertebra based on the C2 plumb line on the preoperative standing lateral radiographs. However, a study with a larger sample size is needed to validate our hypothesis.
角状后凸畸形的矫正手术有其自身的问题，包括早期并发症如神经功能缺损，以及晚期并发症如近端交界性后凸（PJK）和近端交界性失败（PJF）。本文讨论了小儿严重角状后凸畸形中导致PJK的可能机制及其预防策略。我们还将评估未经治疗的PJK的自然病程及其严重后果。
三名患者，两名13岁男性，表现为进行性、无痛性胸腰段脊柱后凸侧弯畸形，节段性后凸分别为100°和140°，脊柱侧弯分别为33°和78°；一名14岁女性，表现为D11 - 12水平顶点处60°的角状后凸畸形。
进行了后路脊柱切除术及节段性畸形矫正，获得了良好的冠状面和矢状面平衡。随访中发现了PJF。两名男性患者进行了二次手术，将内固定延伸至D4并同时进行畸形矫正。女性患者未选择翻修手术，我们正在观察该病例的自然病程。
在矢状面平衡正常或为负的严重胸腰段角状后凸畸形中，根据术前站立位侧位X线片上的C2铅垂线，选择矢状面稳定的椎体作为上固定椎体可能是更安全的选择。然而，需要更大样本量的研究来验证我们的假设。
