Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 80. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | Juvenile Kyphosis Scheuermann s Disease Chapter 28 785 Kyphosis correction by anterior instrumentation and fusion has been performed in some centers very recently. The aims are to save spinal segments and to avoid damage to the paraspinal muscles. There are however no reports yet on the outcome of this procedure. Posterior Approach The basic steps of the classical posterior procedure for Scheuermann s kyphosis are posterior release correction and internal fixation using posterior instrumentation posterior fusion with bone graft Spinal cord monitoring and the possibility for a wake-up test are absolutely indispensable for a safe surgical correction of the kyphotic deformity. Posterior Release Correction and Fusion The goal is shortening of the posterior column to allow for extension of the spine. The posterior release encompasses the resection of spinous processes ligamenta flava upper and lower margins of the laminae facetjoints in the area of the deformity usually four to six segments Fig. 9b c . Instrumentation and correction of the deformity follow the cantilever and posterior tension bend compression principle. The uppermost instrumented vertebra is the upper end vertebra of the deformity. Distally the first lordotic segment caudal to the apex should be included 39 40 41 53 56 . Claw constructs or pedicle screws are used above the apex of the deformity pedicle screws in the lower part of the instrumentation. A two-rod construct Case Study 2 or a four-rod construct can be used for the correction maneuver Fig. 10a b . Stiff rods should be chosen to minimize the risk of loss of correction. Instrumentation includes the upper kyphosis end vertebra and the first lordotic segment a Figure 10. Cantilever technique b Instrumentation correction using cantilever and posterior tension band principle a two-rod technique and b four-rod technique. 786 Section Spinal Deformities and Malformations Case Study 2 A 16-year-old male student was admitted for assessment and treatment
