Peter Metz-Stavenhagen and Walter Morgenstern

Goals of Surgical Treatment

Posterior correction and stabilization of various spinal disorders (especially Scheuermann’s kyphosis, global kyphosis in ankysosing spondylitis, congenital kyphosis, and fracture treatment).

Diagnosis

Pathological thoracic kyphosis is defined as a sagittal deformity between T1 and T12. The diagnosis is established on clinical and radiologic examination. The patient is inspected laterally and sagittal hyperkyphosis is recognized in a standing position as well as in forward bending. Radiologic diagnosis is made with measurement on standing anteroposterior (AP) and lateral x-rays of the spine on a long cassette. Hyperextension films are made to assess the flexibility of the curve and compensatory behavior of the adjacent lumbar or cervical spine. It is important to describe the structural and destructive changes of the vertebrae (wedge vertebra) and congenital malformations.

Indications for Surgery

1. Hyperkypyhosis (i.e., Scheuermann’s disease, ankylosing spondylitis)

2. Congenital kyphotic deformities

3. Fracture treatment

4. Posttraumatic kyphosis

5. Scoliosis

6. Tumors

7. In cases with osteoporotic bone or dysplasias in which hook insertion is difficult or impossible

Contraindications

1. Severe rotation and dysplasia.

2. In fixed deformities it is necessary to release anteriorly.

3. Generally there is no contraindication compared to interpedicular screw placement in the thoracic spine.