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Accelerated anterior vertebral growth resulting in kyphosis correction following posterior spinal instrumented fusion

Abstract

Purpose

To discuss the effect of posterior instrumented deformity correction and fusion on the progressive endochondral ossification of anterior vertebral body in a patient with congenital kyphosis secondary to type 1 vertebral anomaly.

Methods

A 15-year-old male patient presented with a progressively worsening congenital TL kyphosis of 52° magnitude secondary to a posterior hemivertebra. His pre-operative antero-posterior vertebral height ratio (APVHR) and anterior vertebral body defect ratio (AVBDR) on CT were 38% and 49%, respectively. He underwent posterior instrumented deformity correction with multilevel type 1 Schwab osteotomies and fusion.

Results

Over the next 3 years, his serial imaging revealed progressive endochondral ossification and gradual increase in the dimensions of the vertebral body. At the final follow-up, there was a significant restoration of the deficient anterior vertebral body, and the final APVHR and AVBDR were 81% and 90%, respectively.

Conclusions

Restitution of posterior column integrity through stabilization can mitigate the compressive stresses across anterior column. Over a period of time, forces restraining the growth of anterior vertebral apophysis are alleviated, and the vertebra can potentially re-grow to near-normal dimensions in pediatric population. This phenomenon could be well-demonstrated in our patient during follow-up.

Level of evidence I

Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.

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Funding

Sponsored by Ganga Orthopedic Research and Educational Fund (GOREF).

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Dr VKV was involved in data collection, manuscript preparation, approval of manuscript and agreed to be accountable for all aspects of the work. Dr AP manuscript preparation, approval of manuscript and agreed to be accountable for all aspects of the work. Dr RMK and Prof SR were involved in manuscript review, approval of manuscript and agreed to be accountable for all aspects of the work.

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Correspondence to S. Rajasekaran.

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The authors declare that they have no conflict of interst.

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Viswanathan, V.K., Shetty, A.P., Kanna, R.M. et al. Accelerated anterior vertebral growth resulting in kyphosis correction following posterior spinal instrumented fusion. Eur Spine J (2022). https://doi.org/10.1007/s00586-022-07240-9

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  • DOI: https://doi.org/10.1007/s00586-022-07240-9

Keywords

  • Kyphosis correction
  • Remodelling of anterior vertebral body
  • Congenital kyphosis
  • Posterior instrumented deformity correction