Surgical Treatment of Congenital Kyphoscoliosis

Congenital kyphoscoliosis is an abnormal curvature of spine that is due to presence of vertebral anomalies which cause an imbalance in the longitudinal growth of the spine. Congenital kyphoscoliosis is often rigid and its correction can be difficult. It is often resistant to conservative treatment and more patients require surgical treatment than those with idiopathic curvature. The indication for the conservative treatment with Milwaukee brace is much limited. Largely Milwaukee brace is a delaying tactic to correct the spinal curvature until its growth is further advanced and it is more amenable for fusion. This paper was aimed to review our experience with 49 patients with congenital scoliosis, kyphosis and kyphoscoliosis who were treated surgically with various methods of preoperative correction, from Jan. 1968 to Dec. 1983, in special reference to new classification, proposed for common application to both kyphosis and scoliosis, and following results were obtained. 1.The average age when scoliosis was observed was 6.9 years, but the average age of surgery was deferred until 15.2 years. 2. The distribution of curve pattems were 1 cervicothoracic, 24 thoracic, 12 thoracolumbar, 7 lumbar and 1 lumbosacral curve in 45 scoliotic curves and 13 thoracic, 13 thoracolumbar and 4 lumbar curves in 30 kyphotic curves. The average degrees of deformity were most severe in thoracolumbar curves both in kyphosis and scoliosis. 3. The new morphological classification, which could be applicable to both kyphosis and scoliosis, was proposed. The type of unsegmented bar with contralateral hemivertebra was most common both in kyphosis and scoliosis. 4. Preoperative average degrees of scoliosis was 58.7 degrees and final correction was 20.6 degrees (35.1%) with loss of comection of 3.7 degrees (6.3%). Preoperative average degrees of kyphosis was 63.7 degrees and final correction was 20.1 degrees (42.5%) with loss of correction of 7.0 degrees (11.0%). 5. The surgical method with anterior and posterior fusion was the best treatment of severe kyphoscoliossis, in the aspect of final correction and loss of correction. 6. The lumbar curve was most amenable to treatment with the best final correction and the least loss of correction.