Complications in Kyphosis in Children

Introduction

Kyphosis is defined as an abnormal forward spinal curvature in children when looking at the sagittal plane. It can be separated into multiple different types, including postural, Scheuermann, congenital, infectious, traumatic, neuromuscular, degenerative, and postoperative kyphosis after laminectomy or spinal fusion, such as proximal junctional kyphosis (PJK) and distal junctional kyphosis (DJK). Each type requires specific management and special concerns when treating, as rates of progression and instability will be different amongst all groups. Not all types require surgical management, but success rates of nonoperative management vary significantly among the groups. Thus, surgical management is often a mainstay for many of these curve types. It is imperative that surgeons counsel patients based on kyphosis type and projected rate of progression to minimize the chance of future complications in these children. Complications related to Scheuermann kyphosis, congenital kyphosis, PJK, and DJK will be discussed, as the other diagnoses are beyond the scope of this chapter. Similarly, postural kyphosis will be omitted here, because these patients almost never require management beyond observation or physical therapy/nonsteroidal anti-inflammatory drugs if they are symptomatic with back pain. Because the diagnoses leading to kyphosis are all quite different, the treatment algorithms will be similarly different. Each subtype listed above will be examined for complications within both the nonoperative and operative management domains.