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Brian J. Kelley, Michele H. Johnson, Alexander O. Vortmeyer, Brian G. Smith, and Khalid M. Abbed

frequently seen in elderly persons as a consequence of aging, pediatric kyphotic deformity within the thoracolumbar region may be due to congenital, neuromuscular, or idiopathic etiologies. It may also be due to a post-laminectomy effect secondary to a previous procedure. Progressive deformity may lead to problems with ambulation due to sagittal imbalance and, if severe, neurological compromise. Initially, nonsurgical treatment options such as bracing are attempted; however, if these options fail to correct deformity, corrective surgery is required. In this article, we

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Praveen V. Mummaneni, Sanjay S. Dhall, Gerald E. Rodts, and Regis W. Haid

C ervical kyphosis is a particularly challenging problem that can result in progressive deformity and neurological decline. 5 , 43 Advances in spinal instrumentation have led to refinements in the treatment of cervical kyphotic deformity. 15 , 22 , 31 Though it is generally accepted that surgical correction is warranted in cases of progression of kyphosis or neurological decline, the choice of ventral, dorsal, ventral-dorsal, or 3-stage approaches remains debatable. 5 Although many cases of cervical kyphotic deformity can be corrected via an anterior

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Olumide A. Danisa, Dennis Turner, and William J. Richardson

reduction “eggshell” osteotomy procedures to correct kyphotic deformity were performed in 11 patients. We retrospectively assessed the results obtained in this group for sagittal plane correction, pain relief, and blood loss. Charts were reviewed, patients were examined at follow up at 3, 6, and 12 months postoperatively, and follow-up radiographs were acquired to measure correction. The group included eight men and three women whose mean age at the time of operation was 46.6 years (range 23–78 years). In three patients lumbar or thoracolumbar kyphosis secondary to

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Vincent C. Traynelis

T obin et al. share their experience with and technique of T-1 pedicle subtraction osteotomies (PSOs) for the treatment of significant fixed cervical deformities. 3 Upper thoracic osteotomies limit risk to the vertebral artery and C-8 nerve root as compared to a C-7 PSO and still offer an opportunity to achieve substantial correction. The advantages of these procedures have been described by others as well. 1 , 2 Cervical kyphotic deformities are heterogeneous in many regards. There is a spectrum of severity as well as diversity in the region producing kyphosis

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outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy. J Neurosurg (Spine 2) 93: 199–204, October 2000) The authors have demonstrated that up to 21% of their patients developed progression of kyphosis after laminectomy for cervical spondylotic myelopathy: the greater number of these presenting with either straight or kyphotic spine prior to surgery, and only three (14%) of 22 patients with lordotic cervical spines. It is surprising that laminectomy was even considered in the face of kyphosis (four of 46 patients), because kyphosis

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Richard D. Ferch, Amjad Shad, Tom A. D. Cadoux-Hudson, and Peter J. Teddy

T he sagittal alignment of the spine can be altered by diseases affecting the spine or following spinal surgery. The loss of normal cervical lordosis associated with the development of a kyphotic deformity can be progressive. This may lead to adjacent-segment disease and the development of neurological deficit. 36 Biomechanical interactions facilitate this development of progressive deformity, resulting in a bowstring effect on the cord that may compromise its function despite the presence of an adequate canal diameter. 2, 4, 19 Anterior decompression of

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John S. Winestone, Chad W. Farley, Bradford A. Curt, Albert Chavanne, Neal Dollin, David B. Pettigrew, and Charles Kuntz IV

P atients with a cervical or thoracic kyphotic deformity can present a clinical treatment challenge. Two longstanding principles in spinal surgery have been the following: 1) Laminectomy alone for cervical or thoracic kyphotic deformity with myelopathy can be relatively ineffective. 1 , 15 , 18 , 23 , 29–31 2) Operative treatment of cervical or thoracic kyphotic deformity is associated with an increased risk of spinal cord injury. 3 , 13 , 18 , 19 In an animal model of kyphotic deformity, Shimizu and colleagues 27 reported the following results. The

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Ashwin Viswanathan, Katherine Relyea, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen, and Andrew Jea

structures in the thoracic cavity and the thoracic spine itself. 7 , 11 , 18 , 20 , 28 , 34 , 35 Since the early 1990s, however, spine surgeons have been using PSs in the management of thoracic deformities and have not observed any serious vascular or visceral complications. 5 , 9 , 17 , 21 , 31–33 To our knowledge, this is the first report of a pneumothorax directly related to posterior fusion with segmental PS fixation. 31 In the present study we detail a case of pneumothorax after “in-out-in” thoracic PS fixation for a kyphotic deformity correction in a child

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Robert F. Heary and Christopher M. Bono

. 9 , 14 In an extensive review, we found that the PSO-based management of posttraumatic kyphotic deformity has not been described in the neurosurgical literature. The present report represents our experience in the treatment of patients with healed upper-region lumbar burst fractures associated with chronic intractable pain and kyphotic deformity. In addition to providing clinical data obtained in three cases, we describe the technical aspects of the surgical procedure and evaluate the available peer-reviewed literature. Case Presentations Study Overview

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Matthew K. Tobin, Daniel M. Birk, Shivani D. Rangwala, Krzysztof Siemionow, Constantin Schizas, and Sergey Neckrysh

R igid cervical kyphotic deformity represents a very difficult to treat pathology. Its etiology is multifactorial and includes traumatic injuries, degenerative changes, ankylosing spondylitis, and, quite often, iatrogenic factors including postlaminectomy syndrome. The picture becomes more complicated with the presence of either anterior or posterior instrumentation. Traditionally, rigid cervical kyphotic deformity, or “chin-on-chest deformity,” has been measured by the chin-brow vertical angle (CBVA). 6 , 14 , 15 , 25 , 31 This angle is a measurement of