Efficacy analysis of anterior cervical fusion in the treatment of adolescent cervical kyphosis

Abstract

Background Surgical treatment remains a challenge for the treatment of adolescent cervical kyphosis, anterior cervical fusion (ACF) can correct kyphosis with small trauma. To study the efficacy and application scope of ACF for the treatment of adolescent cervical kyphosis. Methods Patients younger than 18 years old who had undergone anterior cervical discectomy/corpectomy and fusion (ACDF/ACCF) for cervical kyphosis from 2013.1 to 2020.12 in our hospital were retrospectively analyzed. The visual analogue scale (VAS) score for neck pain and neck disability index (NDI) were recorded at preoperative and the last follow-up. The C2-7 Cobb angle, regional kyphosis angle (RKA), kyphosis index (KI), T1 slope (T1S), and C2-7 sagittal vertical axis (C2-7 SVA) were measured at preoperative, 1-week post-traction, 1-week postoperative, and last follow-up. Data were analyzed using the SPSS 25.0 software and p < 0.05 refers to a significant difference. Results A total of 11 patients were included, 6 with idiopathic, 1 with laminectomy, 2 with eosinophilic granuloma(EG), and 2 with trauma. All accepted skull-traction, the cervical kyphosis angle shows significant improvement at post-traction than preoperative. 9 patients accepted anterior cervical discectomy and fusion(ACDF), and 2 patients accepted anterior cervical corpectomy decompression and fusion(ACCF). The laminectomy patient occurred distal junctional kyphosis(DJK) at the last follow-up. The VAS score of neck pain and NDI at the last follow-up were smaller than preoperative (p<0.05). The cervical kyphosis angle shows significant improvement at postoperative and the last follow-up than preoperative and post-traction. There is no significant difference in cervical curvature between the postoperative and last follow-up. Conclusion ACF is suited to mild or moderate adolescent cervical kyphosis or can be corrected to mild or moderated by cervical traction. It is effective for improving clinical symptoms with small trauma. For patients with an intact posterior column, ACF is effective for restoring cervical lordosis. For patients without an intact posterior column, ACF-only is not enough, a combined approach should be considered and fused to the thoracic if necessary.