Thoracic pedicle subtraction osteotomy in a pediatric patient: a case report

STUDY DESIGN  Case report. OBJECTIVE  To describe a case of thoracic pedicle subtraction osteotomy (PSO) for congenital kyphosis in a child. BACKGROUND INFORMATION  Although congenital kyphosis is rare, it is a challenging cause of pediatric myelopathy and frank paralysis. Even less common is the use of PSO for the surgical management of focal congenital kyphosis. We present the case of a child with congenital kyphosis that was managed with a pedicle subtraction osteotomy. METHODS  A detailed history and physical examination were performed with careful review of the patient's medical records and x-ray studies. A PSO at T11 was performed along with T9 through L1 instrumented posterolateral fusion. CASE DESCRIPTION  A 10-year-old girl was evaluated for walking difficulty and a lump on her back. Physical examination revealed a sharp gibbus kyphosis in the lower thoracic spine with tenderness and bilateral back muscle spasms. The patient displayed difficulty with balance lacking a smooth, regular gait rhythm. Clonus and radiculopathy were not present. Plain x-ray of the thoracolumbar spine revealed hyperkyphosis and failure of anterior wall segmentation between T10 and T11 vertebral bodies. Cobb's angle measured 65 degrees. Due to her symptoms and degree of correction required, we elected to perform a PSO at T11 along with T9 to L1 posterolateral instrumentation fusion. No intraoperative complications occurred. There was a significant improvement in her posture and gait. DISCUSSION  A thoracic PSO for congenital kyphosis was safely performed with an excellent outcome. To our knowledge, this is the first PSO procedure performed in Uganda.