Kyphoscoliosis

Kyphosis by itself refers to an excessive convex curvature of spine occurring in the thoracic and sacral regions. A normal thoracic curvature from the 1st to the 12th spine has a naturally occurring convex shape with angles ranging from 20 degrees to 45 degrees. When the curvature goes past 45 degrees, the condition is termed as Kyphosis.

Kyphosis, depending on the extent of curvature can result in many discomforts including breathing and digestion difficulties, cardiovascular issues, and even neurological deformities. The greater the extent of deformity, the more pressing the need becomes for a surgery.

Kyphosis by itself is of several types, including postural kyphosis caused by slouching. Such forms of kyphosis can be reversed to a certain extent by correcting muscular imbalances. The more debilitating version of kyphosis is Scheuermann’s kyphosis, found mostly in teenagers. There are few other causes of Kyphosis as well, such as congenital, nutritional or osteoporosis induced and post-traumatic.

Depending on the type of Kyphosis, the extent of curvature, the age of the patient, various treatment modalities can be suggested including the provision for posture correction, braces, physiotherapy for correcting the muscular imbalance, and finally the surgery. Surgery can be most useful in patients who have an extensive deformity. The rate of post-surgery complications may be higher in elderly patients.

Scoliosis refers to yet another form of abnormal curvature in which the person’s spine takes an "S" or "C" shape. Scoliosis has forms of treatments available similar to those for kyphosis including bracing, physical therapy and various types of surgeries. Typically, a human spine is straight laterally, but in scoliosis patients, there may be a curve of ten degrees in either direction, left or right.

Surgery is usually indicated when the extent of deformity is large, causes issues in physiological functions such as breathing, interferes with the daily activities or cosmetically unacceptable to the adult. It is also advised when the patient has passed the age where other therapies such as braces are no longer effective. Kyphoscoliosis implies that the patient has both types of curvature deformity.[4]

The decision to undergo surgery or not is always a complex one, but sometimes, it becomes inevitable such as when the deformity begins to interface with crucial physiological functions like breathing or makes every day normal activities extremely painful. Sometimes, patients in their early adulthood may choose to have surgery because the presence of such deformity causes social issues such as acceptability among their peers, a disability that comes in the way of working, etc. In the case of elderly patients who suffer from such deformity triggered at a later age, other factors are to be considered such as the presence of underlying disease that caused it, whether a progressive decline is expected, and if conservative treatments using physiotherapy or drugs have failed to give relief from debilitating pain.

Surgical correction is attempted in some to fix the spine and arrest progression of the deformity. Surgical operations may include the use of spinal implants like the Harrington Rod, or the VEPTR.

A study measured outcome from surgery of 49 cases of scoliosis and kyphoscoliosis. Of this sample, 36 patients were monitored for a period of 8 years.

• 23% – excellent condition
• 29% – good condition
• 34% – satisfactory
• 14% – bad

'Bad' refers to cases where the surgery failed to address the disease and the patient either had to undergo a revision surgery or continues to suffer from a poor quality of life as before surgery.

Typically post-surgery complications range up to 5% involving all major and minor complications when measured within one year of surgery. However, there may be a progressive decline in patient's condition after a few years.

In another study that evaluated surgical treatment of kyphoscoliosis and scoliosis due to congenital reasons, 91% of surgeries were found to be successful and met their intended objectives for the two-year follow-up period after surgery. The sample consisted of 23 patients of whom 17 were male and 6 were female, with an average age of 27 years, ranging from 13 to 61 years. The most popular type of surgeries for spinal correction includes pedicle subtraction osteotomy (PSO) and posterior vertebral column resection (pVCR).

Another study which focused on elderly patients found that the rate of complications was much higher for a sample population of 72 cases with mean age of 60.7 years. The rate of complications was as high as 22% in the entire sample. The study points that in the case of elderly patients, surgery should only be considered when there is no other option left; the disease is in progression stage, and the quality of life has degraded to an extent where conservative treatments can no longer help with pain.

While there are many surgical approaches for spinal deformity correction including anterior only, posterior only, anterior-posterior, the techniques that are most popular nowadays include the posterior only VCR or pVCR. One of the studies which analyze pVCR technique also noted the benefit of using a technique called NMEP monitoring in assisting the surgeon avoid any neurological complications while performing a spine surgery.