[Surgical treatment of kyphosis in children and adolescents]. / Operative Therapie von Kyphosen im Kindesalter.

ABSTRACT

OBJECTIVE: Correction of a pathological kyphosis to restore a balanced, low-pain or pain-free and load-bearing spine. INDICATIONS Pronounced sagittal imbalance, progressive kyphosis despite conservative therapy, and neurological deficits are indications for surgery. Further surgical indications are severe therapy-resistant complaints and/or psychologically burdening cosmetic impairment. The guidelines for surgical indications are kyphosis angles of 75-80° thoracic and 30-50° lumbar. CONTRAINDICATIONS No specific, but general contraindications for surgical treatment. SURGICAL TECHNIQUE Depending on the characteristics of the kyphosis, different surgical techniques are used. Rod-screw systems are mainly used, and surgery is primarily performed by shortening the spinal column from posterior using a wide variety of techniques. In individual cases, this can be combined with ventrally mobilizing, resecting, or straightening techniques. POSTOPERATIVE MANAGEMENT The aim of surgical treatment is to achieve a primarily stable and weight-bearing spine. Regular wound control as well as stabilizing physiotherapy during follow-up are essential. Postoperatively, initially abstaining from sports; later physical activity is encouraged under professional guidance. RESULTS: The literature shows very good corrective results in children and adolescents. The technical procedures are associated with a low and acceptable complication rate. Over the course of time, these patients must be monitored in order to detect possible long-term complications such as junctional kyphosis or pseudarthrosis.