Thoracic and thoracolumbar kyphosis in adults

Study Design. Author experience and literature review. Objectives. To investigate the spectrum of adult kyphosis and to discuss the various surgical and nonsurgical treatment options. Summary of Background Data. Kyphosis with its various etiologies and associated pathophysiologies has been discussed in the literature for many decades. The nonsurgical treatment primarily consists of symptom reduction via physical therapy and has not changed significantly for decades. The surgical treatment, however, has changed dramatically. A decade ago, most large kyphotic deformities required anterior and posterior procedures. With the advent of numerous posterior osteotomy techniques and pedicle fixation, most of these deformities are now treated via posterior methods only. Methods. Using literature review and the author's experience, kyphosis and its characteristics will be discussed. Important details pertinent to presurgical planning and execution of surgical will be discussed. three cases will be presented to illustrate the surgical treatment options for three qualitatively different kyphotic deformities. Results. Flexible kyphotic deformities may respond well to aggressive facetectomies and cantilever corrections. Multisegmental osteotomies may be most appropriate for long sweeping deformities. Fixed, sharply, angulated deformities may respond best to pedicle subtraction osteotomies or vertebral column resections. Conclusions. Segmental pedicle screw fixation coupled with one of four posterior osteotomy/resection techniques can be used to address most sagittal plain deformities. Careful application of these techniques is important. Smith-Petersen and Ponte osteotomies are most appropriate for long sweeping deformities with mobile anterior columns. Pedicle subtraction osteotomies and vertebral column resections are most appropriates for fixed, sharply angulated spinal deformities. The successful application of these techniques is dependent on accurate preoperative evaluation of the structural properties of the kyphosis and meticulous execution of the surgical technique.