Skip to main content
SpringerLink
Log in

Pediatric iatrogenic thoracic kyphosis and tension myelopathy treated with a thoracic pedicle subtraction osteotomy: a case report and review of the literature

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Purpose

Pediatric kyphotic deformity is an uncommon clinical entity that can occur following posterior spinal operations and has significant complexity in its treatment. Tension myelopathy in a pediatric patient with a thoracic kyphotic deformity has not been reported in the literature.

Case report

We present a 17-year-old boy with a progressive thoracic kyphosis and tension myelopathy 4 years after he underwent a thoracic laminoplasty at an outside institution for the treatment of a dorsal spinal arachnoid cyst. At our institution, he was treated with a pedicle subtraction osteotomy as well as thoracic Ponte osteotomies for sagittal plane correction to relieve the tension myelopathy.

Conclusions

Both clinical and radiographic improvements were observed after surgery. We review the literature on pediatric thoracic kyphosis and tension myelopathy and the treatment of these pathologies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Amhaz HH, Fox BD, Johnson KK, Whitehead WE, Curry DJ, Luerssen TG, Jea A (2009) Postlaminoplasty kyphotic deformity in the thoracic spine: case report and review of the literature. Pediatr Neurosurg 45(2):151–154. doi:10.1159/000209655

    Article  PubMed  Google Scholar 

  2. Bakaloudis G, Lolli F, Di Silvestre M, Greggi T, Astolfi S, Martikos K, Vommaro F, Barbanti-Brodano G, Cioni A, Giacomini S (2011) Thoracic pedicle subtraction osteotomy in the treatment of severe pediatric deformities. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 20(Suppl 1):S95–S104. doi:10.1007/s00586-011-1749-y

    Article  Google Scholar 

  3. Bradford DS, Garica A (1969) Neurological complications in Scheuermann’s disease. A case report and review of the literature. J Bone Joint Surg Am 51(3):567–572

    CAS  PubMed  Google Scholar 

  4. Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A(Suppl 1):44–50

    PubMed  Google Scholar 

  5. Campos MA, Weinstein SL (2007) Pediatric scoliosis and kyphosis. Neurosurg Clin N Am 18(3):515–529. doi:10.1016/j.nec.2007.04.007

    Article  PubMed  Google Scholar 

  6. Cheh G, Lenke LG, Padberg AM, Kim YJ, Daubs MD, Kuhns C, Stobbs G, Hensley M (2008) Loss of spinal cord monitoring signals in children during thoracic kyphosis correction with spinal osteotomy: why does it occur and what should you do? Spine 33(10):1093–1099. doi:10.1097/BRS.0b013e31816f5f73

    Article  PubMed  Google Scholar 

  7. Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C (2005) Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 30(18):2030–2037, discussion 2038

    Article  PubMed  Google Scholar 

  8. Coe JD, Smith JS, Berven S, Arlet V, Donaldson W, Hanson D, Mudiyam R, Perra J, Owen J, Marks MC, Shaffrey CI (2010) Complications of spinal fusion for Scheuermann kyphosis: a report of the scoliosis research society morbidity and mortality committee. Spine 35(1):99–103. doi:10.1097/BRS.0b013e3181c47f0f

    Article  PubMed  Google Scholar 

  9. de Jonge T, Slullitel H, Dubousset J, Miladi L, Wicart P, Illes T (2005) Late-onset spinal deformities in children treated by laminectomy and radiation therapy for malignant tumours. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 14(8):765–771. doi:10.1007/s00586-004-0778-1

    Article  Google Scholar 

  10. Diab MG, Franzone JM, Vitale MG (2011) The role of posterior spinal osteotomies in pediatric spinal deformity surgery: indications and operative technique. J Pediatr Orthop 31(1 Suppl):S88–S98. doi:10.1097/BPO.0b013e3181f73bd4

    Article  PubMed  Google Scholar 

  11. Dobbs MB, Lenke LG, Kim YJ, Luhmann SJ, Bridwell KH (2006) Anterior/posterior spinal instrumentation versus posterior instrumentation alone for the treatment of adolescent idiopathic scoliotic curves more than 90 degrees. Spine 31(20):2386–2391. doi:10.1097/01.brs.0000238965.81013.c5

    Article  PubMed  Google Scholar 

  12. Fau R, Djindjian R, Crouzet G, Perret J, Larribau E (1973) Regressive paraplegia and Scheuermann’s disease. Radio-clinical study of a case. Rev Neurol 129(2):83–90

    CAS  PubMed  Google Scholar 

  13. Ghosh PS, Moodley M, Friedman NR, Rothner AD, Ghosh D (2011) Hirayama disease in children from North America. J Child Neurol 26(12):1542–1547. doi:10.1177/0883073811409226

    Article  PubMed  Google Scholar 

  14. Gill JB, Levin A, Burd T, Longley M (2008) Corrective osteotomies in spine surgery. J Bone Joint Surg Am 90(11):2509–2520. doi:10.2106/jbjs.h.00081

    Article  PubMed  Google Scholar 

  15. Haft H, Ransohoff J, Carter S (1959) Spinal cord tumors in children. Pediatrics 23(6):1152–1159

    CAS  PubMed  Google Scholar 

  16. Hwang SW, Riesenburger RI, Benzel EC (2007) Pediatric iatrogenic spinal deformity. Neurosurg Clin N Am 18(4):585–598. doi:10.1016/j.nec.2007.05.001

    Article  PubMed  Google Scholar 

  17. Imajo Y, Kato Y, Kanchiku T, Suzuki H, Taguchi T (2011) Pathology and prognosis of proximal-type cervical spondylotic amyotrophy: new assessment using compound muscle action potentials of deltoid and biceps brachii muscles. Spine 36(7):E476–E481. doi:10.1097/BRS.0b013e3181e08d93

    Article  PubMed  Google Scholar 

  18. Katsumi Y, Honma T, Nakamura T (1989) Analysis of cervical instability resulting from laminectomies for removal of spinal cord tumor. Spine 14(11):1171–1176

    Article  CAS  PubMed  Google Scholar 

  19. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H (2001) Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine 26(4):391–402

    Article  CAS  PubMed  Google Scholar 

  20. Kelley BJ, Johnson MH, Vortmeyer AO, Smith BG, Abbed KM (2012) Two-level thoracic pedicle subtraction osteotomy for progressive post-laminectomy kyphotic deformity following resection of an unusual thoracolumbar intradural extramedullary tumor. J Neurosurg Pediatr 10(4):334–339. doi:10.3171/2012.7.peds11526

    Article  PubMed  Google Scholar 

  21. Kumar R, Srivastava AK, Tiwari RK (2011) Surgical management of Pott’s disease of the spine in pediatric patients: a single surgeon’s experience of 8 years in a tertiary care center. J Pediatr Neurosci 6(Suppl 1):S101–S108. doi:10.4103/1817-1745.85726

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  22. La Marca F, Brumblay H (2008) Smith-Petersen osteotomy in thoracolumbar deformity surgery. Neurosurgery 63(3 Suppl):163–170. doi:10.1227/01.neu.0000320428.67620.4f

    Article  PubMed  Google Scholar 

  23. Levine DN (1997) Pathogenesis of cervical spondylotic myelopathy. J Neurol Neurosurg Psychiatry 62(4):334–340

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Li Y, Remmel K (2012) A case of monomelic amyotrophy of the upper limb: MRI findings and the implication on its pathogenesis. J Clin Neuromuscul Dis 13(4):234–239. doi:10.1097/CND.0b013e3182461afc

    Article  PubMed  Google Scholar 

  25. Lu F, Wang H, Jiang J, Chen W, Ma X, Ma X, Xia X, Wang L (2013) Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial. J Neurosurg Spine 19(4):412–419. doi:10.3171/2013.4.SPINE12575

    Article  PubMed  Google Scholar 

  26. Luhmann SJ, Lenke LG, Kim YJ, Bridwell KH, Schootman M (2005) Thoracic adolescent idiopathic scoliosis curves between 70 degrees and 100 degrees: is anterior release necessary? Spine 30(18):2061–2067

    Article  PubMed  Google Scholar 

  27. Lunardi P, Licastro G, Missori P, Ferrante L, Fortuna A (1993) Management of intramedullary tumours in children. Acta Neurochir 120(1–2):59–65

    Article  CAS  PubMed  Google Scholar 

  28. Mayfield JK, Riseborough EJ, Jaffe N, Nehme ME (1981) Spinal deformity in children treated for neuroblastoma. J Bone Joint Surg Am 63(2):183–193

    CAS  PubMed  Google Scholar 

  29. McGirt MJ, Chaichana KL, Atiba A, Bydon A, Witham TF, Yao KC, Jallo GI (2008) Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty. J Neurosurg Pediatr 1(1):57–62. doi:10.3171/ped-08/01/057

    Article  PubMed  Google Scholar 

  30. McGirt MJ, Garces-Ambrossi GL, Parker SL, Sciubba DM, Bydon A, Wolinksy JP, Gokaslan ZL, Jallo G, Witham TF (2010) Short-term progressive spinal deformity following laminoplasty versus laminectomy for resection of intradural spinal tumors: analysis of 238 patients. Neurosurgery 66(5):1005–1012. doi:10.1227/01.neu.0000367721.73220.c9

    Article  PubMed  Google Scholar 

  31. Meyer NJ, Flatley TJ, Dunn DD (2003) Superiorly based laminoplasty in children: average 6.8-year follow-up of 21 patients. J Spinal Disord Tech 16(2):156–162

    Article  PubMed  Google Scholar 

  32. O’Sullivan C, Jenkin RD, Doherty MA, Hoffman HJ, Greenberg ML (1994) Spinal cord tumors in children: long-term results of combined surgical and radiation treatment. J Neurosurg 81(4):507–512. doi:10.3171/jns.1994.81.4.0507

    Article  PubMed  Google Scholar 

  33. Papagelopoulos PJ, Peterson HA, Ebersold MJ, Emmanuel PR, Choudhury SN, Quast LM (1997) Spinal column deformity and instability after lumbar or thoracolumbar laminectomy for intraspinal tumors in children and young adults. Spine 22(4):442–451

    Article  CAS  PubMed  Google Scholar 

  34. Ratliff JK, Cooper PR (2003) Cervical laminoplasty: a critical review. J Neurosurg 98(3 Suppl):230–238

    PubMed  Google Scholar 

  35. Raynor RB, Pugh J, Shapiro I (1985) Cervical facetectomy and its effect on spine strength. J Neurosurg 63(2):278–282. doi:10.3171/jns.1985.63.2.0278

    Article  CAS  PubMed  Google Scholar 

  36. Sariali E, Panier S, Glorion C (2009) Mechanical spinal cord compression at the apex of a kyphosis: a propos of one case. Review of the literature. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deformity Soc Eur Sect Cervical Spine Res Soc 18(Suppl 2):160–164. doi:10.1007/s00586-008-0733-7

    Article  Google Scholar 

  37. Shikata J, Yamamuro T, Shimizu K, Saito T (1990) Combined laminoplasty and posterolateral fusion for spinal canal surgery in children and adolescents. Clin Orthop Relat Res 259:92–99

    PubMed  Google Scholar 

  38. Silverstein MP, St Clair SF, Lieberman IH (2012) Thoracic pedicle subtraction osteotomy in a pediatric patient: a case report. Evid-Based Spine-Care J 3(2):49–54. doi:10.1055/s-0031-1298618

    Article  PubMed Central  PubMed  Google Scholar 

  39. Smith JT, Gollogly S, Dunn HK (2005) Simultaneous anterior-posterior approach through a costotransversectomy for the treatment of congenital kyphosis and acquired kyphoscoliotic deformities. J Bone Joint Surg Am 87(10):2281–2289. doi:10.2106/jbjs.d.01795

    Article  PubMed  Google Scholar 

  40. Smith-Petersen MN, Larson CB, Aufranc OE (1969) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res 66:6–9

    CAS  PubMed  Google Scholar 

  41. Sponseller PD, Jain A, Lenke LG, Shah SA, Sucato DJ, Emans JB, Newton PO (2012) Vertebral column resection in children with neuromuscular spine deformity. Spine 37(11):E655–E661. doi:10.1097/BRS.0b013e318244460d

    Article  PubMed  Google Scholar 

  42. Yeh JS, Sgouros S, Walsh AR, Hockley AD (2001) Spinal sagittal malalignment following surgery for primary intramedullary tumours in children. Pediatr Neurosurg 35(6):318–324

    Article  CAS  PubMed  Google Scholar 

  43. Zdeblick TA, Abitbol JJ, Kunz DN, McCabe RP, Garfin S (1993) Cervical stability after sequential capsule resection. Spine 18(14):2005–2008

    Article  CAS  PubMed  Google Scholar 

Download references

Disclosure

The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. This manuscript has not been previously published in whole or in part or submitted elsewhere for review.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Tufts Medical Center and Tufts University School of Medicine, 800 Washington St, Box #178, Boston, MA, 02111, USA

    Mina G. Safain, Rachel B. Engelberg, Ron Riesenburger, James Kryzanski & Steven W. Hwang

  2. Department of Neurosurgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA

    Andrew Jea

Authors
  1. Mina G. Safain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rachel B. Engelberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ron Riesenburger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James Kryzanski
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Jea
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Steven W. Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Steven W. Hwang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Safain, M.G., Engelberg, R.B., Riesenburger, R. et al. Pediatric iatrogenic thoracic kyphosis and tension myelopathy treated with a thoracic pedicle subtraction osteotomy: a case report and review of the literature. Childs Nerv Syst 30, 1293–1299 (2014). https://doi.org/10.1007/s00381-014-2373-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-014-2373-z

Keywords

Search

Navigation