Surgical treatment of congenital kyphosis caused by multiple vertebral malformations

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Abstract

Clinical case of successful operative treatment of congenital kyphosis is reported. Deformation was caused by multiple lower thoracic and lumbar vertebral body abnormalities. Associated spinal abnormalities were outspread absence of laminae, hydromyelia, and diastematomyelia. Preoperative computed tomography analysis revealed absence of instrumentable bony structures within malformed lower thoracic and lumbar spine. As instrumented fusion procedure was technically impossible anterior fusion without internal fixation was performed. Autogenous rib was used as a bone graft. Bone graft was extended with calcium sulphas (osteoconductive media), demineralized allograft bone matrix (osteoinductive media), and patient’s bone marrow aspirate (osteogenic media). Resulting combined bone grafting material possessed osteoconductivity, osteoinductivity, ostegenicity, and mechanical strength. At 18 months post operation follow-up computed tomography revealed solid bony fusion formation. Some neurologic improvement also was noticed. Congenital kyphosis caused by multiple outspread vertebral malformations remains insufficiently studied clinical problem. Affected children need individual multidisciplinary surgical approach, meticulous surgical planning, and regular neurological, imaging, and orthopedic follow-up until the end of bone growth. Absence of instrumentable bony structures in desired spinal arthrodesis does not preclude successful fusion. Combination of several heterogenous bone grafting materials with different properties provides fusion in difficult clinical setting.

About the authors

Artem V. Kosulin

St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: hackenlad@mail.ru

Assistant Professor, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Dmitriy V. Elyakin

St. Petersburg State Pediatric Medical University

Email: dimaelkins@mail.ru

Pediatric Surgeon, Surgical Department No 2

Russian Federation, Saint Petersburg

Ekaterina I. Okhlopkova

St. Petersburg State Pediatric Medical University

Email: oket2008@rambler.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Olesya G. Pridatko

St. Petersburg State Pediatric Medical University

Email: seventhseeker@yandex.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Yuliya V. Klybanskaya

St. Petersburg State Pediatric Medical University

Email: julieklyban@gmail.com

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

Vladislav S. Dvoretskiy

St. Petersburg State Pediatric Medical University

Email: butler4@mail.ru

Student, Department of Operative Surgery and Topographic Anatomy

Russian Federation, Saint Petersburg

References

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Supplementary files

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2. Fig. 1. Preoperative computed tomography: a – multiple vertebral formation, fusion, and segmentation failure (anterior view); b – complete transverse defect of lumbar spine anterior structures (left view); c – split posterior structures of lower thoracic and lumbar spine (posterior view)

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3. Fig. 2. Preoperative magnetic resonance imaging: a – Th5-Th6 hydromyelia; b – split cord below Th7

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4. Fig. 3. Computed tomography at 18 months postoperative follow up. Solid bone fusion: a – anterior view; b – left view

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Copyright (c) 2018 Kosulin A.V., Elyakin D.V., Okhlopkova E.I., Pridatko O.G., Klybanskaya Y.V., Dvoretskiy V.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
 


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