Verma Satish Kumar, Singh Pankaj Kumar, Kumar Amandeep, Sawarkar Dattaraj, Laythalling Rajinder Kumar, Chandra Poodipedi S, Kale Shashank S
Department of Neurosurgery, Institute of Medical Sciences, Neurosciences Centre, New Delhi, 110029, India.
Childs Nerv Syst. 2023 Jan;39(1):239-247. doi: 10.1007/s00381-022-05697-z. Epub 2022 Oct 11.
To study clinical and radiological outcomes of pediatric cervical kyphosis correction with a standalone posterior cervical approach. Cervical spine kyphotic deformity in pediatric age group is a distinct entity and the management is challenging. Pediatric cervical kyphosis is less often encountered, and literature is sparse with only few case series. Management algorithms are devised keeping the flexibility of the deformity at the core of decision making. Circumferential fusion is mostly recommended for non-flexible (rigid) kyphosis.
Authors present a single center retrospective analysis of cases of pediatric cervical kyphosis managed by a standalone posterior approach. Pre- and post-operative clinical and radiological parameters were recorded and analyzed. Changes in neurological status, kyphosis correction and bony fusion were assessed. Surgical and implant related complications were noted.
Seven cases (6 male, 1 female) were included. Mean age was 13.9±2.9 years, ranging from 8-17 years. Etiology was traumatic in 2 cases, developmental in 2, and syndromic, Hirayama disease and post-laminectomy in 1 case each. Mean kyphosis correction was 36.80±19.30 (87%±21%) with a mean pre-operative kyphosis angle of 37.80±15.30 and mean immediate post-operative kyphosis angle of 3.70±8.70. Mean hospital stay duration was 10±6 days. Median follow-up duration was 36 months. Myelopathy improved in 5 cases at last follow-up. Six cases demonstrated bony fusion at a mean follow-up of 8.4±1.5 months.
Significant immediate correction in pediatric cervical kyphosis may be achieved with a standalone posterior approach with proper planning and technique in selected cases. Inserting pedicle screws at strategic locations of implant construct offer better corrections and pull-out strength and maintain long-term stability resulting in higher arthrodesis rates. Larger studies with longer follow up are needed to further ascertain the role of standalone posterior cervical approaches in pediatric cervical kyphosis.
研究采用单纯后路颈椎手术治疗小儿颈椎后凸畸形的临床及影像学疗效。小儿颈椎后凸畸形是一种特殊的疾病，其治疗具有挑战性。小儿颈椎后凸畸形相对少见，相关文献较少，仅有少数病例系列报道。制定治疗方案时，需将畸形的柔韧性作为决策的核心。对于僵硬的后凸畸形，大多建议采用前后路联合融合术。
作者对采用单纯后路手术治疗小儿颈椎后凸畸形的病例进行单中心回顾性分析。记录并分析术前及术后的临床和影像学参数。评估神经功能状态、后凸畸形矫正情况及骨融合情况。记录手术及植入物相关并发症。
共纳入7例患者（男6例，女1例）。平均年龄为13.9±2.9岁，范围为8 - 17岁。病因方面，创伤性2例，发育性2例，综合征性、平山病及椎板切除术后各1例。平均后凸畸形矫正角度为36.80±19.30（87%±21%），术前平均后凸畸形角度为37.80±15.30，术后即刻平均后凸畸形角度为3.70±8.70。平均住院时间为10±6天。中位随访时间为36个月。末次随访时，5例脊髓病患者病情改善。6例在平均随访8.4±1.5个月时实现了骨融合。
在特定病例中，通过合理规划和技术操作，采用单纯后路手术可显著即刻矫正小儿颈椎后凸畸形。在植入物结构的关键位置植入椎弓根螺钉可提供更好的矫正效果和拔出强度，并维持长期稳定性，从而提高融合率。需要开展更大规模、更长随访时间的研究，以进一步明确单纯后路颈椎手术在小儿颈椎后凸畸形治疗中的作用。
