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Instrumented Fusion and Osteotomy
With progressive kyphotic curves in older children, surgery may include instrumentation (rods, hooks, and screws) that helps to correct the deformity. If the spinal cord is unable to tolerate the manipulative techniques that "straighten" the spine, the surgeon may consider the removal of the mis-shapened vertebrae to realign the spine. The postoperative course remains the same until the fusion mass is determined by X-ray to be solid.
Your surgeon may recommend an osteotomy (bone-cutting procedure) to re-align the spine. Pedicle subtraction osteotomies work by removing the bone in the back of the vertebra so the bone can be collapsed backwards. Vertebral column resections allow resection of the front and the back of the spine from a posterior procedure. The surgeon may also recommend separate approaches from the front and the back of the spine.
A&B) Front and side views of a child with lumbar kyphosis.
The yellow dots outline the hemi-vertebra (wedged vertebra) on B.
C & D) A CT reconstruction and MRI showing the hemi-vertebra.
E) The red-shaded area shows the bone removed in the pedicle subtraction osteotomy.
F&G) Front and side views of the child after surgery showing full correction of the curve.