Figure 2 - uploaded by Kuniyoshi Abumi
Content may be subject to copyright.
Correction of fixed kyphosis by bony fusion. Patients with fixed kyphosis underwent circumferential osteotomy consisting of focetectomies (A), anterior corpectomy with uncinectomy (B), posterior correction using pedicle screw fixation and anterior strut grafting (C).
Source publication
This retrospective study was conducted to analyze the clinical results in 30 patients with cervical kyphosis that had been treated using cervical pedicle screw fixation systems.
To evaluate the effectiveness of a pedicle screw fixation procedure in correction of cervical kyphosis.
Correction of cervical kyphosis is a challenging problem in the fiel...
Contexts in source publication
Context 1
... fixed kyphosis caused by bony fusion underwent circum- ferential osteotomy, posterior correction using pedicle screw fixation, and anterior strut grafting sequentially under one an- esthesia ( Figure 2). The circumferential osteotomy consisted of corpectomy, bilateral uncinectomy, and bilateral facetecto- mies. ...
Context 2
... in the correction of kyphosis by short- ening of the posterior portion of the vertebrae by using pedicle screw fixation, screws contact the inferior artic- ular process of the cranial vertebra. Therefore, further shortening of the posterior portion enlarges the interver- tebral foramen, as shown in Figures 1 and 2, and the chance of nerve root lesion by iatrogenic foraminal ste- nosis in the correction of kyphosis using pedicle screw fixation is relatively low. ...
Similar publications
The aim of this stusy was to investigate whether spinal fusion to T2, T3, or T4 affects sagittal alignment of the cervical spine in Lenke 1 adolescent idiopathic scoliosis (AIS) patients.
A retrospective study comprised of 64 Lenke 1 AIS patients was performed to assess the radiographic and clinical outcome. According to the upper instrumented vert...
Certain cervical spinal conditions require decompression and reconstruction of the entire subaxial cervical spine. There are limited data concerning the clinical details and outcomes of patients treated in this manner. The object of this study was to describe the specific technique employed to perform a total subaxial reconstruction and review the...
Citations
... Several factors were supposed to be associated with cervical spine kyphosis development, including neuromuscular disorders, trauma, ankylosing spondylitis, psychiatric conditions, and post-laminectomies [9][10][11][12]. Cervical surgery seems to be the leading iatrogenic etiology of cervical spine kyphosis, which may be associated with post-operative distortions or pseudoarthrosis in the natural cervical lordosis [13][14][15]. ...
Introduction and importance
Acute idiopathic cervical kyphosis (AICK) represents a rare entity, and its management remains controversial. Preoperative surgical planning and individual decision-making seem necessary. To date, there is a lack of sufficient evidence and clear guidelines.
Case presentation
A 21-year-old male was referred with a progressive cervical deformity detected 3 months earlier. The patient suffered from severe progressive myelopathy and represented neither neck trauma nor a familial history of similar expected conditions. His cervical imaging revealed 95 degrees of cervical kyphosis. After 3 separate surgical sessions for 360-degree fixation, the cervical kyphosis was reduced by 90 degrees. No facet dislocation was observed, and laminectomy was unnecessary. Post-operative neurological examination detected significant improvement. Six months and 2-year follow-ups were favorable. To the authors' knowledge, the current case had the most extensive degree of cervical kyphosis reported in the literature.
Clinical discussion
Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications. Particular attention should be paid to the wide inter-spinous spaces in high grades of kyphosis during sub-periosteal dissection to prevent iatrogenic spinal cord injuries.
Conclusion
The present work may provide the first report on the role of cervical postural habits in patients with opiate substance abuse disorder, which could have triggered cervical kyphosis in this particular patient. Multistage correction of AICK would result in a favorable outcome and reduce the risk of complications.
... The anterior approach was historically preferred because of its familiarity; however, the results with a higher incidence of cage subsidence, pseudoarthrosis, and failure of curve correction. As such, there has been a preference for posterior approaches with the aid of pedicle screws with higher stability and pullout strength [39,40]. The anterior approach alone or as a part of 360 • reconstructions is limited to rigid curves. ...
Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe “chin-on-chest” deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group.
... Many studies have been conducted on partial lordosis and total spinal alignment correction using indirect decompression with a posterior approach 1,2,17) . In our study, the indirect decompression group showed lower WA and T-L junction angles. ...
Objective: Approximately 90% of spinal fractures occur at the thoracolumbar (T-L) junction and may be accompanied by neurological symptoms, in which decompression and post-fixation are generally performed. However, decompression surgery can aggravate patients’ symptoms due to adverse incidents, such as developing postoperative hematomas or iatrogenic spinal cord injury. This study compared the surgical and radiographic outcomes of patients with T-L junction burst fractures and neurological deficits who underwent direct or indirect decompression.Methods: We retrospectively reviewed all patients who had undergone posterior surgical treatment for T-L junction burst fractures with neurologic deficits. Patients were classified according to the procedure: indirect decompression (group 1) or spinal decompression through laminectomy and facetectomy (group 2). Clinical results and radiologic findings were compared between the two groups for 2 years.Results: Among 57 patients who met the inclusion criteria, 29 were categorized into group 1, and 28 were categorized into group 2. Group 1 had a statistically significantly lower Oswestry Disability Index score than group 2 at the final follow-up visit (p=0.03). In group 1, both the T-L junction angle and wedge angle of the injured vertebrae improved significantly, both immediately after surgery (p=0.02 and p=0.01, respectively) and at the final follow-up visit (p=0.01 and p=0.01, respectively). In group 2, the difference between the pelvic incidence and lumbar lordosis was significantly greater than in group 1 at the final follow-up visit (p=0.02).Conclusion: This study confirmed that symptoms could be sufficiently improved with indirect decompression, which should be kept in mind for cases where it is difficult to perform direct decompression
... 72 In 2010, Walter et al. 73 presented five patients with cervical suppurative infection, one of whom had a 2.7° cervical kyphosis, while the other four patients had varying degrees of loss of lordosis (0.2°-3.1°). However, Abumi et al. 74 reported a case of cervical kyphosis caused by a suppurative infection of the cervical spine, with a local kyphosis Angle of 35° at the affected site. In addition, in the study of O'Shaughnessy et al. 75 of patients with rigid cervical kyphosis, they included a patient with cervical kyphosis secondary to a suppurative infection, with a kyphosis angle of 38°. ...
... 213 where the Cobb angle changes by < 10° between flexion and extension. In the study of Abumi et al., 74 13 patients with rigid cervical kyphosis underwent circular osteotomy and posterior fusion, and the kyphotic angle was corrected from +31° preoperatively to +1° at the last follow-up. No complications related to internal fixation and bone graft occurred in all patients after the operation. ...
A healthy cervical spine with normal movement is the basis of many daily activities and is essential for maintaining a good quality of life. However, the alignment, fusion, and structure of the cervical spine can change for various reasons, leading to cervical deformity, mainly kyphosis. Approximately 5%‒20% of spinal infections in the cervical spine cause cervical deformity. The deformity can recover early; however, the disease's long-term existence or the continuous action of abnormal stress may lead to intervertebral fusion and abnormal osteophytes. Many gaps and controversies exist regarding infectious cervical deformities, including a lack of clear definitions and an acceptable classification system thereby requiring further research. Moreover, there is no consensus on the indications for postinfectious cervical deformity associated with Mycobacterium tuberculosis, Staphylococcus aureus, and Brucellosis. Therefore, we reviewed and discussed the incidence, clinical manifestations, changes, and treatment of infectious and inflammatory secondary cervical deformities from common to rare to provide a theoretical basis for clinical decision-making.
... Full texts of the remaining studies were similarly screened for final inclusion by the same authors. The final included studies met the following criteria: (1) reported clinical or radiographic outcomes of CPS or LMS placement in subaxial cervical vertebra (C3-6); (2) described complication rates intraoperatively or postoperatively, or both; and (3) only included patients with fusions between the levels of C2 and T1. Studies were grouped as CPS or LMS according to how the C3-6 screws were placed. ...
... A previous limitation of the CPS approach was the potential risk of neurovascular structure compromise due to the trajectory of the pedicle [77]. However, with the subsequent incorporation of navigation-guided CPS placement, recent studies have demonstrated decreased rates of complications and improved outcomes [1,22,28]. Of the studies in our review that included CPS placement with navigation, the data had no observed heterogeneity (I 2 = 0%). ...
Lateral mass screw (LMS) and cervical pedicle screw (CPS) fixation are among the most popular techniques for posterior fusion of the cervical spine. Early research prioritized the LMS approach as the trajectory resulted in fewer neurovascular complications; however, with the incorporation of navigation assistance, the CPS approach should be re-evaluated. Our objective was to report the findings of a meta-analysis focused on comparing the LMS and CPS techniques in terms of rate of various complications with inclusion of all levels from C2 to T1. We conducted a systematic review of PubMed and EMBASE databases with final inclusion criteria focused on identifying studies that reported outcomes and complications for either the CPS or LMS technique. These studies were then pooled, and statistical analyses were performed from the cumulative data. A total of 60 studies comprising 4165 participants and 16,669 screws placed within the C2-T1 levels were identified. Within these studies, the LMS group had a significantly increased odds for lateral mass fractures (odds ratio [OR] = 43.2, 95% confidence interval [CI] = 2.62-711.42), additional cervical surgeries (OR = 5.56, 95%CI = 2.95-10.48), and surgical site infections (SSI) (OR = 5.47, 95%CI = 1.65-18.16). No other significant differences between groups in terms of complications were identified. Within the subgroup analysis of navigation versus non-navigation-guided CPS placement, no significant differences were identified for individual complications, although collectively significantly fewer complications occurred with navigation (OR = 5.29, 95%CI = 2.03-13.78). The CPS group had significantly fewer lateral mass fractures, cervical revision surgeries, and SSIs. Furthermore, navigation-assisted CPS placement was associated with a significant reduction in complications overall.
... (2) Radiological evaluation: the C2−7 Cobb angle of the cervical spine and C2−7 sagittal vertical axis (SVA) were measured preoperatively, postoperatively, and at the last followup. The C2−7 Cobb angle [17] is the angle between the vertical line connecting the C2 ...
... (2) Radiological evaluation: the C2-7 Cobb angle of the cervical spine and C2-7 sagittal vertical axis (SVA) were measured preoperatively, postoperatively, and at the last follow-up. The C2-7 Cobb angle [17] is the angle between the vertical line connecting the C2 upper endplate and the C7 lower endplate measured on a standard lateral X-ray, and the angle was positive for cervical lordosis and negative for cervical kyphosis. The C2-7SVA [18] is the distance between the vertical line through the center of C2 and the vertical line through the upper corner after C7. (3) Clinical functional evaluation: the visual analog scale (VAS) was used to score neck, shoulder, and upper limb pain before and after surgery and at the last follow-up. ...
... The main goals of surgical treatment of DCM should be to adequately decompress, correct the deformity and re-establish stability [21][22][23][24][25]. Anterior surgery and CPS effectively reconstruct and maintain cervical lordosis, and our results are consistent with the literature [12,14,16,17,26,27]. In the present study, the C2-7 cobb angle was significantly increased in both groups, without significant loss of cervical lordosis in either group at the final follow-up. ...
(1) Background: The choice of surgical access for 4-level degenerative cervical myelopathy (DCM) remains controversial, and the clinical and radiological outcomes of anterior surgery using a low-profile cage (Low-P) versus posterior surgery using cervical pedicle screw fixation (CPS) have not been compared. (2) Methods: This is a retrospective controlled study conducted between January 2019 and June 2021 of 72 patients with 4-level DCM who underwent ACDF using a low-profile cage (n = 39) or laminectomy and instrument fusion using CPS (n = 33). The minimum follow-up time was 12 months. The outcomes were C2–7Cobb angle, C2–7sagittal vertical axis (SVA) fusion rate, the Japanese Orthopedic Association (JOA) score, pain visual analog scale (VAS), neck disability index (NDI), and complications. (3) Results: Both anterior and posterior procedures significantly improved the patients’ quality-of-life parameters. Anterior cervical convexity and SVA significantly increased in both groups, but the SVA was greater in the posterior group than in the anterior group (p < 0.001). The C2–7 Cobb angle significantly improved in both groups postoperatively, and at the final follow-up, there was a slight but nonsignificant reduction in cervical lordosis in both groups (p = 0.567). There was a longer operative time, less intraoperative blood loss, and reduced mean hospital stay in the anterior group compared to the posterior group, with two cases of postoperative hematoma requiring a second operation, two cases of axial pain (AP), five cases of dysphagia, two cases of c5 palsy in the anterior group, and four cases of axial pain, and three cases of c5 palsy in the posterior group. According to Bridwell fusion grade, anterior fusion reached grade I in 28 cases (71.8%) and grade II in 10 cases (25.6%) in the anterior group, and posterior fusion reached grade I in 25 cases (75.8%) and grade II in 8 cases (24.2%) in the posterior group. (4) Conclusions: There was no difference between the anterior and posterior surgical approaches for MDCM in terms of improvement in neurological function. Posterior surgery using CPS achieved similar recovery of cervical anterior convexity as anterior surgery with a shorter operative time but was more invasive and had a greater increase in SVA. The use of Low-P in anterior surgery reduced the incidence of dysphagia and cage subsidence and was less invasive, but with a longer operative time.
... Standalone posterior approaches require strong but sequential forces applied across the screw-rod construct initially for distraction followed by compression over a contoured rod to correct the deformity. Pedicle screw insertion, preferably at all levels, but at least at the proximal and distal ends of the construct, provides a strong pull-out strength for the cantilever mechanism to correct the deformity and maintain the correction for more loading cycles; however, they are technically demanding [13,14]. Kotani et al. demonstrated that cervical pedicle screws offer a strength that is comparable to anterior plating and posterior wiring combined together [13]. ...
... Kotani et al. demonstrated that cervical pedicle screws offer a strength that is comparable to anterior plating and posterior wiring combined together [13]. Abumi et al. used only cervical pedicle screws in cervical kyphosis correction and were able to reduce the degree of kyphosis from 28.4 to 5.1° and achieved solid fusion in all their cases [14]. ...
Purpose
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.
Methods
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.
Results
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.
Conclusion
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.
... Although these treatment approaches are effective in cervical stabilization, mechanically, the cervical transpedicular screwing technique provides a stronger structure than other techniques and is less likely to fail [9,26]. Biomechanical studies have reported that cervical pedicle screws provide superior stabilization to other posterior cervical fixation applications [26][27][28]. Cervical pedicle screws are not only effective for traumatic or nontraumatic conditions, but also for the treatment of diseases such as kyphosis and spondyloarthropathy [29][30][31]. This technique improves the bone union rate by providing stabilization of pedicle screws in slow bone union requiring high biomechanical immobility and can help with rehabilitation by shortening the time after surgery [32]. ...
Background:
Cervical instability can be caused by a variety of factors, including trauma, tumors, or infection. The cervical transpedicular screw (CPS) is one of the most modern procedures for treating cervical instability. Despite the fact that numerous innovative techniques for CPS have been proposed, the appropriate screw entry points and screw directions have yet to be thoroughly established. The aim of this study is to determine the screw insertion angles and screw entry point distances based on reference points, pedicle axis lengths, and pedicle axis intersections for each vertebra from cervical (C) C2 to C7 in both right and left by gender and age groups.
Methods:
In this study, computed tomography (CT) images of patients who underwent cervical examination for any reason were evaluated retrospectively. A total of 100 patients (59 men and 41 females), ranging in age from 18 to 79 years (mean 43 years), were randomly selected for the study. Patients with a history of cervical pathology or surgery were excluded. CT images turned into 3D reconstructed images and density settings were made so that bone tissue could be best observed using OsiriX software. Pedicle axis length (PAL), pedicle transverse angle (PTA), pedicle sagittal angle (PSA), distance of screw entry point to lateral notch (DLN), distance of screw entry point to inferior articular process (DIAP), and pedicle axis intersections were measured.
Results:
According to our findings, the optimal entry point should be 2-4 mm medial to the lateral notch and 8-12 mm superior to inferior articular process. PTA ranges between 30 to 45°, while PSA ranges between 11 to 15°. Except for the C2 pedicles, which were slightly shorter, the pedicle axis lengths (PAL) were similar from C3 to C7 in the total group. The intersection of the right and left pedicle axes was determined to be the most in C4 (51.21% in females and 72.88% in males).
Discussion:
This study has shown that intersections of the pedicle axis must be considered in both genders, especially in C4. Standardizing optimal entry points and trajectories is crucial for improving the CPS technique's safety and effectiveness.
... A better assessment of the bone structure is provided by CT images, which should be taken systematically not only for diagnostic purposes but also to predict the correct placement of the screws on the lateral masses. However, it is the MRI study in which images provide the most data to demonstrate the lesion of the posterior tension band [34]. The use of dynamic MRI has also been proposed for evaluation since patients with a spinal cord diameter of less than 6 mm in flexion are at risk of neurological deficit. ...
... A better assessment of the bone structure is provided by CT images, which should be taken systematically not only for diagnostic purposes but also to predict the correct placement of the screws on the lateral masses. However, it is the MRI study in which images provide the most data to demonstrate the lesion of the posterior tension band [34]. ...
The atlantoaxial joint C2 (axis) with the anterior arch of C1 (atlas) allows 50% of cervical lateral rotation. It is responsible for precise and important movements that allow us to perform precise actions, both in normal and working life. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed and the outcome is worse. An early diagnosis and treatment are essential to ensure satisfactory neurological and functional outcomes. The aim of this review is to analyze C1-C2 rotatory subluxation in adults, given its rarity. The time between injury and reduction is key, as it is directly related to prognosis and the severity of the treatment options. Due to low incidence in adults, this condition often goes undiagnosed, or the diagnosis is delayed as a lot of cases are not related to a clear trauma, with a poor prognosis just because of the late diagnosis and the outcome is worse. The correct approach and treatment of atlantoaxial dislocation requires a careful study of the radiological findings to decide the direction and plane of the dislocation, and the search for associated skeletal anomalies.
... They include but not limited to trauma, neuromuscular disease, psychiatric condition, ankylosing spondylolitis and postlaminectomies. [6][7][8][9] The most common iatrogenic cause of CK is secondary to cervical surgery, 10 which may be linked to post-surgery pseudoarthrosis or distortions in the natural cervical lordosis. It has been observed that young adults and the pediatric population are susceptible to postlaminectomy cervical kyphosis (PLCK). ...
... 13 A kyphotic spine interrupts the natural alignment of the head in relation to the spine transmitting abnormal forces, consequently, deformity progression. 6 A study reported that the trapezius muscle and other neck extensors such as the splenius capitis and semispinalis capitis play a crucial role in strengthening and supporting the neck. As a result, a constant neck flexion gradually weakens these supporting muscles of the neck due to overstretching. ...
Background:
Although it has been established that adolescent idiopathic cervical kyphosis (AICK) has no known cause, there are associated risk factors. However, the underlying causes remain puzzling. This case report presents severe AICK linked to chronic neck flexion postural habit, treated with combined anterior and posterior correction surgery and review of the literature.
Case presentation:
A 16-year-old male with no history of trauma, surgery, or family history of spinal deformity complained of intolerable neck pain and rigidity. He developed an incessant reading of comic books at a very young age, and he preferred placing the book on the floor with his head flexed between his thighs. Acupuncture and massage therapy failed to relief symptoms. He had no neurological symptoms on examination and X-ray showed Cobb angle of 70.5°. MRI and CT scans showed no spinal cord compression or osteophyte formation. A combined anterior and posterior correction surgery was performed after a week of skull traction. The deformity was corrected, neck pain disappeared, and neck rotatory function maintained after posterior implant removal. The maximum follow-up was 10 years.
Conclusions:
The potential underlying risk factor observed in this case is unusual. Chronic neck flexion postural habit is a potential risk factor of severe AICK in some individuals.
