TY  - JOUR
T1  - Simultaneous Anterior-Posterior Approach Through a Costotransversectomy for the Treatment of Congenital Kyphosis and Acquired Kyphoscoliotic Deformities
AU  - Smith, John T.
AU  - Gollogly, Sohrab
AU  - Dunn, Harold K.
Y1  - 2005/10/01
N1  - 10.2106/JBJS.D.01795
JO  - The Journal of Bone & Joint Surgery
SP  - 2281
EP  - 2289
VL  - 87
IS  - 10
N2  - 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.
SN  - 0021-9355
M3  - doi: 10.2106/JBJS.D.01795
UR  - http://dx.doi.org/10.2106/JBJS.D.01795
ER  -