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Correction of pediatric cervical kyphosis: our experience and systematic-literature review

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Abstract

Background

Pediatric cervical kyphosis is a distinct entity with diverse etiology (congenital, syndromic, traumatic, metabolic or neoplastic). Surgical correction in pediatric population is challenging due to their growing spine and low blood volume.

Purpose

To analyse their presentation, surgical techniques and outcome of pediatric cervical kyphosis and systematically review the pertinent literature.

Design

Retrospective study.

Patient sample

16 patients aged ≤ 18 years who underwent correction for cervical kyphosis between 2009 and 2021.

Outcome measures

Nurick’s grading, mJOA score and Global cobb’s angle.

Methods

Clinical parameters (Nurick grading and mJOA score) were noted from database on admission and on follow-up at 6 months. Radiological parameters of assessment included Global Cobb’s angle. The C2–C7 Cobb angle was the angle of C2 vertebra lower end plate and C7 vertebra lower end plate. For C1–2 kyphosis, anterior border of C1 and anterior border of C2 angle was taken. Radiographic parameters were studied on CT and radiographs of cervical spine to assess for stability, the degree of deformity correction and fusion status at 6 months follow-up.

Results

16 patients with mean age of 14.2 ± 3 years (9 syndromic, 4 post-traumatic, 2 metabolic and 1 post-laminectomy). All underwent surgical correction, 6 underwent Antero-posterior spinal fusion, 6 underwent Posterior spinal fusion and 4 underwent Anterior spinal fusion. There was significant clinical improvement postoperatively with—Nurick grade (pre vs. post: 2.8 vs. 1.8, p = 0.004), mJOA score (pre vs. post: 11.3 vs. 14, p = 0.003). There was significant deformity correction of Cobb’s angle from 40.7 ± 26.5° to 14.9 ± 10° (p = 0.001). Early complications included intraoperative hemodynamic instability (3) and wound complication (1). Mean follow-up was 76.9 ± 59.3 months.

Conclusion

Pediatric cervical kyphosis is a debilitating condition which are managed surgically. Approach has to be individualized to the pathology and good results can be achieved. Patients should be screened for syndromic association and followed-up regularly.

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Data availability

The data that support the findings of this study are available from the corresponding author, PKS, upond reasonable request.

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Author notes

  1. Sivaraman Kumarasamy and Dattaraj Parmanand Sawarkar have contributed equally and both are first authors.

Authors and Affiliations

  1. Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India

    Sivaraman Kumarasamy, Dattaraj Parmanand Sawarkar, Pankaj Kumar Singh, Rajinder Kumar, Poodipedi Sarat Chandra & Shashank Sharad Kale

Authors
  1. Sivaraman Kumarasamy
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  2. Dattaraj Parmanand Sawarkar
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  3. Pankaj Kumar Singh
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  4. Rajinder Kumar
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  5. Poodipedi Sarat Chandra
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  6. Shashank Sharad Kale
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Contributions

SK: Conceptualisation of the work, acquisition, analysis and interpretation of data. Drafted the work. Approved the final version for publications. Accountable for all aspects of the work. DPS: Conceptualisation of the work, acquisition, analysis and interpretation of data. Drafted the work. Approved the final version for publications. Accountable for all aspects of the work. PKS: Conceptualisation and design of the work and interpretation of data. Revised the work for intellectual content. Approved the final version for publication. Accountable for all aspects of the work. RK: Design of the work. Revised the work for intellectual content. Approved the final version for publication. Accountable for all aspects of the work. PSC: Design of the work. Revised the work for intellectual content. Approved the final version for publication. Accountable for all aspects of the work. SSK: Design of the work. Revised the work for intellectual content. Approved the final version for publication. Accountable for all aspects of the work.

Corresponding author

Correspondence to Pankaj Kumar Singh.

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Conflict of interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethics approval

Approved from Institute ethics committee (IECPG-428/26.05.2022, RT-40/30.06.2022).

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Informed consent taken from all the patients before inclusion into study.

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Kumarasamy, S., Sawarkar, D.P., Singh, P.K. et al. Correction of pediatric cervical kyphosis: our experience and systematic-literature review. Spine Deform (2024). https://doi.org/10.1007/s43390-023-00809-4

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