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Simultaneous Anterior-Posterior Approach Through a Costotransversectomy for the Treatment of Congenital Kyphosis and Acquired Kyphoscoliotic Deformities
John T. Smith, MD1; Sohrab Gollogly, MD1; Harold K. Dunn, MD2
1 Department of Pediatric Orthopedics, Primary Children's Medical Center, 100 North Medical Drive, Suite 4550, Salt Lake City, UT 84113. E-mail address for J.T. Smith: john.smith@hsc.utah.edu. E-mail address for S. Gollogly: sgollogly@hotmail.com
2 Department of Orthopedics, University of Utah Medical Center, 30 North 1900 East, Room 3B165, Salt Lake City, UT 84132-2302. E-mail address: harold.dunn@hsc.utah.edu
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The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Primary Children's Medical Center, Salt Lake City, Utah

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Oct 01;87(10):2281-2289. doi: 10.2106/JBJS.D.01795
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Background: Congenital kyphosis and acquired kyphoscoliotic deformities are uncommon but are potentially serious because of the risk of progressive deformity and possible paraplegia with growth. Our current approach for the treatment of these deformities is to use a single posterior incision and costotransversectomy to provide access for simultaneous anterior and posterior resection of a hemivertebra or spinal osteotomy, followed by anterior and/or posterior instrumentation and arthrodesis. To our knowledge, this approach has not been reported previously.

Methods: The medical records and radiographs for sixteen patients who had been managed at our institution for the treatment of congenital kyphosis and acquired kyphoscoliosis between 1988 and 2002 were analyzed. The mean age at the time of surgery was twelve years. The diagnosis was congenital kyphosis for fourteen patients and acquired kyphoscoliotic deformities following failed previous surgery for two. The mean preoperative kyphotic deformity was 65° (range, 25° to 160°), and the mean scoliotic deformity was 47° (range, 7° to 160°). Fifteen patients were managed with vertebral resection or osteotomy through a single posterior approach and costotransversectomy, anterior and posterior arthrodesis, and posterior segmental spinal instrumentation. The other patient was too small for spinal instrumentation at the time of vertebral resection. A simplified outcome score was created to evaluate the results.

Results: The mean duration of follow-up was 60.1 months. The mean correction of the major kyphotic deformity was 31° (range, 0° to 82°), and the mean correction of the major scoliotic deformity was 25° (range, 0° to 68°). Complications occurred in four patients; the complications included failure of posterior fixation requiring revision (one patient), lower extremity dysesthesias (one patient), and late progressive pelvic obliquity caudad to the fusion (two patients). The outcome, which was determined with use of a simplified outcomes score on the basis of patient satisfaction, was rated as satisfactory for thirteen patients, fair for two patients, and poor for one patient.

Conclusions: A simultaneous anterior and posterior approach through a costotransversectomy is a challenging but safe, versatile, and effective approach for the treatment of complex kyphotic deformities of the thoracic spine, and it minimizes the risk of neurologic injury.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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