Three-stage surgery in the management of severe rigid angular kyphosis.

There are conflicting data regarding the management of rigid kyphosis. None of the currently known techniques can completely correct severe kyphosis without resulting in residual deformity. Seven patients with local kyphosis exceeding 60 degrees were operated on to achieve complete correction of the deformity. The surgery consisted of total spondylectomy of the deformed vertebra and simultaneous application of compression-distraction forces to this area. The operation included three stages: The initial stage includes resection of posterior spinal elements and temporary fixation. In the second stage, an anterior corpectomy is performed to conclude the resection, and simultaneous antero-posterior correction is obtained. The final stage includes another posterior procedure to achieve a precise correction and to correct any compensatory curves. All patients were operated on using this technique in a single session. The mean preoperative and postoperative kyphosis angles were 76.1 degrees (range, 65 degrees -92 degrees) and 6 degrees (range, 0 degrees -13 degrees), respectively. Complete bony fusion was achieved after a mean follow-up period of 38 months (range, 26-52 months) without any neurological sequelae or significant loss of correction.