Treatment of cervical kyphosis in children

Children with severe cervical kyphosis present a difficult treatment challenge. The most common etiology of this deformity is extensive laminectomies, especially associated with postlaminectomy irradiation. The deformity can be rapidly progressive leading to neurologic involvement. With intact posterior elements, kyphosis can occur as a result of congenital, traumatic, metabolic or neoplastic processes. Treatment is directed towards early recognition, arrest of the progression of deformity, and improvement of neurologic symptoms. Patients with loss of posterior elements can be treated effectively by preoperative traction and a single-staged anterior release with strut fusion. Patients with intact posterior elements require preoperative traction, initial posterior osteotomies with intraoperative traction, then an anterior release with strut fusion. All patients need rigid postoperative halo immobilization for a minimum of 3 to 4 months to maintain position. Using these techniques, nine patients were treated surgically with satisfactory outcomes.