When Should Kyphosis Surgery Be Considered?
Kyphosis surgery is generally considered for curvatures exceeding 80 degrees. This does not always mean that surgery is necessary. If patients have cosmetic concerns and experience back pain, and if the condition progresses despite physical therapy and brace treatment, surgical intervention should be considered.
Surgical Method and Level Determination
In surgery, similar to scoliosis surgery, a procedure known as fusion surgery is performed through a straight incision from the back (posterior). Pedicle screws are placed in the vertebrae previously determined through radiological evaluation, and the correction is done with two rigid rods placed on these screws. Determining the level, meaning from which vertebra to start at the top and where to end at the bottom, is essential to avoid the risk of junctional kyphosis, which is the re-development of curvature from where the screws end. Even if the level determination is done correctly, junctional kyphosis is one of the long-term complications that may occur after this surgery. To minimize the risk of junctional kyphosis, it is crucial to determine the correct levels, preserve soft tissues, muscles, and ligaments at the uppermost and lowest levels, and avoid corrections above 50% in children with high pelvic incidence as indicated by radiological parameters.
Preoperative Preparation and Techniques for Kyphosis Surgery
Before the surgery, a fulcrum bending X-ray is taken to understand the flexibility of the kyphosis. The surgical technique is determined based on this flexibility. In patients with good flexibility, correction can be achieved simply by placing screws and adjusting the rods. However, in patients with poor flexibility, it is often necessary to perform osteotomies (e.g., Ponte osteotomy, Smith-Petersen osteotomy) to cut the bony structures at the back of the vertebrae, and in rare cases, pedicle subtraction osteotomy or even posterior vertebral column resection (usually for congenital cases) may be required.
Postoperative Period for Kyphosis Surgery
Patients typically stay in the hospital for an average of four days and are mobilized the day after surgery. A slight increase in height can also occur after surgery. There is usually no need for patients to use a brace post-surgery. Contact sports (e.g., soccer, basketball) are prohibited for approximately one year. However, heavy contact sports (e.g., American football) and intense combat sports (e.g., wrestling, boxing) are generally not recommended. These recommendations are not highly evidence-based and can vary based on the physician’s preference and the level of fusion.