Kyphosis

Developmental Kyphosis

Surgical Treatment

Spinal Fusion
When the kyphotic deformity has become severe (greater than 80o) and the patient is often experiencing increased back pain, surgical treatment may be recommended. Surgical intervention allows significant correction to be achieved typically without the need for postoperative bracing. Pedicle screws are placed (2 per level) and connected with two rods. This process allows gentle straightening of the spine. Most surgeries are performed from the back. However, some physicians recommend additional surgery on the front of the spine. Patients are usually able to return to normal daily activities within 4-6 months following surgery. The correction achieved from surgical intervention is remarkable (Figure 1).

A: Preoperative photo of patient with severe kyphosis secondary to Scheuermann's disease. B: Preoperative x-ray of the same patient. C: Postoperative photos of the same patient one year after surgical correction of the kyphosis. D: Postoperative x-ray of the same patient.

Figure 1: A) Preoperative photo of patient with severe kyphosis secondary to Scheuermann's disease. B) Preoperative x-ray of the same patient. C) Postoperative photos of the same patient one year after surgical correction of the kyphosis. D) Postoperative x-ray of the same patient.

Smith-Peterson (Posterior) Osteotomy
Moderately flexible curves often straighten just from lying prone (face down) on the operating room table. However, rigid curves require additional steps. The Smith-Peterson osteotomy is often performed at multiple levels to allow safe application of additional corrective forces. Every spinal segment is limited in extension (backward bend) by two sliding facet joints. If these joints are removed, and the disc in front is mobile, approximately 5-10°/level of additional extension is possible to obtain (Figure 2).

A & B) Front and side X-rays of a person with severe, rigid Scheuremann’s kyphosis. C) An illustration of a side view of the spine showing how the facet joints are removed. D) After the facets are removed, the spine can be tilted backward. E & F) Front and side X-rays after surgery.

Figure 2: A & B) Front and side X-rays of a person with severe, rigid Scheuremann’s kyphosis. C) An illustration of a side view of the spine showing how the facet joints are removed. D) After the facets are removed, the spine can be tilted backward. E & F) Front and side X-rays after surgery.

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