Correction of post-traumatic and congenital kyphosis. Indications, techniques, results

Post-traumatic kyphosis necessitates surgical correction mostly because of pain and also secondary neurological complications. In the majority of cases the cause is iatrogenic due to incorrect or non-indicated conservative or erroneous surgical treatment, because the severity of the injury was incorrectly estimated and the pathomechanical situation was ignored. The basic biofunctional principles of spinal reconstruction (load distribution and dorsal tension banding system) as well as structural rebalancing must be respected even during secondary correction interventions. A variety of open or closed wedge osteotomy procedures are available which can be adapted to the individual pathologic situation and carried out in combination or as a purely dorsal operation technique. The results are good with elimination of pain in 80% and normalization of the spinal function. The interventions are very demanding. Because a misalignment without serious instability will often remain undetected for 5-20 years due to compensatory mechanisms of the spinal column, the traumatologist must be conscious of and accept the necessity for the primary operation to be anatomically justified and correctly carried out. Congenital kyphosis with rapid progression develops mostly due to dorsal formation of hemivertebrae. It is highly likely that dorsal formation of hemivertebrae will lead to neurological deficits, therefore, early diagnosis and surgery is necessary as soon as progression of kyphosis becomes evident. Resection of the apical vertebral body and/or the apical spinal section has proven to be of value. Presently, the majority of surgical interventions are performed using a dorsal approach and should include bilateral costotransversectomy. Modern pedicle instrumentation has created completely new surgical possibilities not only for adult patients but also for infants. These types of surgical interventions require a much higher level of skill of the surgeon and are also associated with significant neurological complications. Therefore, they should only be performed in specialized spine centres. Intraoperative SEP and MEP monitoring are indispensable and under difficult anatomical situations especially in infants intraoperative Iso-C-3D navigation can be very useful.