Abstract
Surgical treatment of adult kyphosis is an old procedure (Ferguson, Hallock, Roaf, Moe). According to conventional concepts, surgery should be reserved for adolescents with curvatures exceeding 75° or with rapidly progressive kyphoses despite treatment with braces or casts and adults with symptomatic curves greater than 65°. Therefore, it is important to evaluate these factors, in addition to the angular level of the kyphosis, to determine the most suitable type of treatment.
The presence of pain should not be considered an absolute indication for treatment in view of the disease’s benign natural evolution. Thus, the only true indication for treatment is the severity of the angle of the curvature, which has been shown to progress over time. Generally, in Scheuermann kyphosis it is suggested that three or four double pedicular transverse or laminar hook configurations be used on the spine above the apex of the kyphosis; this gives an excellent hold on the posterior arch and minimises the risk of neurologic impairment. The use of a transpeduncular screw in the first two lumbar levels increases the stability of the assembly.
In cases of extreme vertebral rigidity posterior multilevel osteotomy is also indicated. In cases of extreme vertebral rigidity anterior arthrodesis is indicated. This is performed by means of an intrathoracic approach or thoracoabdominal retropritoneal approach. The technique makes it possible to resect the anterior longitudinal ligament and to perform multiple discectomies at apical vertebral levels. It is also possible to perform combined anterior and posterior arthrodesis.
