Vibhu Krishnan Viswanathan1, Ajoy Prasad Shetty2, Rishi Mukesh Kanna2, S Rajasekaran3. 1. Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India. 2. Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India. 3. Department of Orthopedics and Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India. sr@gangahospital.com.
Abstract
PURPOSE: To discuss the effect of posterior instrumented deformity correction and fusion on the progressive endochondral ossification of anterior vertebral body in a patient with congenital kyphosis secondary to type 1 vertebral anomaly. METHODS: A 15-year-old male patient presented with a progressively worsening congenital TL kyphosis of 52° magnitude secondary to a posterior hemivertebra. His pre-operative antero-posterior vertebral height ratio (APVHR) and anterior vertebral body defect ratio (AVBDR) on CT were 38% and 49%, respectively. He underwent posterior instrumented deformity correction with multilevel type 1 Schwab osteotomies and fusion. RESULTS: Over the next 3 years, his serial imaging revealed progressive endochondral ossification and gradual increase in the dimensions of the vertebral body. At the final follow-up, there was a significant restoration of the deficient anterior vertebral body, and the final APVHR and AVBDR were 81% and 90%, respectively. CONCLUSIONS: Restitution of posterior column integrity through stabilization can mitigate the compressive stresses across anterior column. Over a period of time, forces restraining the growth of anterior vertebral apophysis are alleviated, and the vertebra can potentially re-grow to near-normal dimensions in pediatric population. This phenomenon could be well-demonstrated in our patient during follow-up. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
PURPOSE: To discuss the effect of posterior instrumented deformity correction and fusion on the progressive endochondral ossification of anterior vertebral body in a patient with congenital kyphosis secondary to type 1 vertebral anomaly. METHODS: A 15-year-old male patient presented with a progressively worsening congenital TL kyphosis of 52° magnitude secondary to a posterior hemivertebra. His pre-operative antero-posterior vertebral height ratio (APVHR) and anterior vertebral body defect ratio (AVBDR) on CT were 38% and 49%, respectively. He underwent posterior instrumented deformity correction with multilevel type 1 Schwab osteotomies and fusion. RESULTS: Over the next 3 years, his serial imaging revealed progressive endochondral ossification and gradual increase in the dimensions of the vertebral body. At the final follow-up, there was a significant restoration of the deficient anterior vertebral body, and the final APVHR and AVBDR were 81% and 90%, respectively. CONCLUSIONS: Restitution of posterior column integrity through stabilization can mitigate the compressive stresses across anterior column. Over a period of time, forces restraining the growth of anterior vertebral apophysis are alleviated, and the vertebra can potentially re-grow to near-normal dimensions in pediatric population. This phenomenon could be well-demonstrated in our patient during follow-up. LEVEL OF EVIDENCE I: Diagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.
Authors: Battugs Borkhuu; Durga K Nagaraju; Gilbert Chan; Larry Holmes; William G Mackenzie Journal: Spine (Phila Pa 1976) Date: 2009-07-15 Impact factor: 3.468