Outcome Analysis of Surgical Management of Paediatric Cervical Kyphotic Deformity (CKD): An Institutional Experience

INTRODUCTION: Paediatric cervical kyphotic deformity (CKD) is extremely rare and occurs due to congenital, traumatic, metabolic or neoplastic processes which mandates surgical correction. Most outcomes analysis following surgery are small retrospective case series and are limited to specific etiology or surgical technique. METHODS: Patients (aged ≤ 18 years) operated at a tertiary centre between January 2009 to April 2022 were included. Besides demographic details, the outcome measures assessed were clinical (Nurick grading, mJOA score), radiological (Cobb’s angle) and operative complications. RESULTS: A total of twenty-two patients were included, with mean age of 12.90 4.02 years (3 – 18) of which ten were syndromic, three were metabolic, seven were post-traumatic and one post-infective. Thirteen patient had features of myelopathy on presentation. All underwent surgical correction, of which nine patients underwent Antero-posterior approach, eight patients underwent Posterior only approach and four patients underwent Anterior only approach. Clinically, patients improved postoperatively with – Nurick grade (pre vs. post: 3.24 vs. 2.24, p – 0.172), mJOA score (pre vs. post: 10.19 vs. 12.71, p – 0.679). There was significant deformity correction from 37.086° to 13.725° (p – 0.045). Mean blood loss encountered was 680 ± 671.93 cc. Early complications included intraoperative hemodynamic instability (4) and lung collapse (1). Late complications included junctional kyphosis (1). Mean follow-up was 49.38 ± 44.15 months. CONCLUSIONS: Pediatric CKD are rare, debilitating condition which can be managed surgically. Antero-posterior approach provides circumferential decompression and better correction compared to Anterior only and posterior only approach. Patients should be screened for syndromic association and regularly followed.