The Journal of Bone and Joint Surgery, Vol 62, Issue 8 1291-1301, Copyright © 1980 by Journal of Bone and Joint Surgery, Inc
Congenital kyphosis due to defects of anterior segmentation
JK Mayfield, RB Winter, DS Bradford and JH Moe
Twenty-seven patients with Type-II congenital kyphosis (failure of anterior
vertebral segmentation) all had progression of the kyphosis which varied in
magnitude. The average rate of progression was 5 degrees per year. Pain due
to compensatory lumbar hyperlordosis (eight patients) and objectionable
deformity (fifteen patients) were the most frequent complaints. Unlike
patients with Type-I kyphosis (failure of vertebral formation), paraplegia
did not occur and associated congenital anomalies were infrequent (three of
the twenty-seven patients). Spontaneous ossification of the anterior part
of seemingly normal intervertebral discs leading to bar formation and
progression of deformity occurred in five patients. A Milwaukee brace had
little effect on this fixed kyphotic deformity in the six patients in whom
the brace was used. Early recognition and spine fusion are the recommended
treatment. Posterior fusion is sufficient in young children with
progressive deformity, whereas combined two-stage anterior and posterior
fusion with osteotomy of the anterior bar is recommended in children with
severe deformity.
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