The Journal of Bone and Joint Surgery (American). 2008;90:1726-1729.
doi:10.2106/JBJS.G.01190
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Infantile Thoracolumbar Kyphosis Secondary to Lumbar Hypoplasia

Mauricio A. Campos, MD1, Pedro Fernandes, MD2, Lori A. Dolan, PhD3 and Stuart L. Weinstein, MD3

1 Department of Orthopaedic Surgery, Pontificia Universidad Católica de Chile, Marcoleta 352 Interior, Santiago, Chile. E-mail address: macampos{at}med.puc.cl
2 Department of Orthopaedic Surgery, University Hospital Santa Maria, Avenue Professor Egas Moniz 1649-028, Lisbon, Portugal. E-mail address: pfpcm{at}iol.pt
3 Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242. E-mail address for L.A. Dolan: lori-dolan{at}uiowa.edu. E-mail address for S.L. Weinstein: stuart-weinstein{at}uiowa.edu
Investigation performed at the University of Iowa Hospitals and Clinics, Iowa City, Iowa

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

Background: There is a normal transition from the kyphotic alignment that is present in the spine of the newborn to the normal sagittal contours that are present in the adult spine. Although abnormal kyphosis at the thoracolumbar junction in infants is rare, it can result from congenital anomalies and bone dysplasias. We report the cases of seven otherwise normal infants who had thoracolumbar kyphosis due to lumbar hypoplasia, with total spontaneous resolution over time.

Methods: The medical records of seven patients who met the inclusion criteria were reviewed. Clinical data and radiographs were analyzed to rule out the presence of congenital anomalies or bone dysplasias. Progression of kyphosis was measured on serial radiographs made with the patient sitting and standing.

Results: All patients were managed conservatively with observation alone. No patient had a neurologic deficit. The average age at the time of the initial diagnosis was 5.3 months, and the average duration of follow-up was 5.7 years. Three cases of kyphosis were secondary to L1 hypoplasia, and four were secondary to L2 hypoplasia. The average initial kyphosis was 34.2°, which progressed to 0.4° of lordosis at the time of the latest follow-up.

Conclusions: Thoracolumbar kyphosis in normal infants secondary to lumbar hypoplasia may resolve spontaneously. After congenital anomalies and bone dysplasias are ruled out, a period of observation is advised.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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