Surgical treatment algorithm for thoracic and lumbar hyperkyphosis in pediatric population.

Purpose: There is no standardized and universally accepted surgical treatment for thoracic and lumbar hyperkyphosis in children. A surgical treatment algorithm was developed to aid in the choice of the appropriate corrective technique.

Methods: A retrospective analysis was conducted of patients younger than 18 years who underwent primary correction surgery and posterior fusion for thoracic and lumbar hyperkyphosis. Patients were categorized according to the classification of Rajasekaran et al. and divided into 2 groups: a posterior column osteotomies (PCO) group and a three-column osteotomies (3CO) group. We analyzed the angularity and flexibility of the curve, global sagittal balance, and preoperative neurological status of the patient.

Results: Forty-nine patients were included. The mean age was 12.8 years (1-18) and the mean preoperative kyphosis was 93.5° (40°-175°). In the PCO group (N = 30), the sagittal deformity angular ratio (DAR) was less than 16.5 in 26 patients (86.6%), while in the 3CO group (N = 19), sagittal DAR was greater than 16.5 in 17 patients (89.4%). In the PCO group (N = 28), the T1-Pelvic angle (TPA) was less than 17° in 19 patients (67.8%), while in the 3CO group (N = 15), TPA was greater than 17° in 10 patients (66.6%). Five patients (10.2%) had recent-onset or progressive neurological alteration, all of them (100%) required 3CO.

Conclusion: An algorithm for kyphosis was developed based on the classification by Rajasekaran et al., preoperative analysis of the angularity and flexibility of the curve, global sagittal balance and neurological status of the patient, to aid in the choice of the appropriate corrective osteotomy.

Level of evidence: IV.