Thoracolumbar Kyphosis in Adolescents with Achondroplasia Who Resolves

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Thoracolumbar Kyphosis in Adolescents with Achondroplasia: Who Resolves and Who Progresses? Tyler Kreitz MD

Thoracolumbar Kyphosis in Adolescents with Achondroplasia: Who Resolves and Who Progresses? Tyler Kreitz MD Oussama Abousamra MD John Heydemann MD William Mackenzie MD Suken Shah, MD

Background § TLK 50% children with achondroplasia 1 § Occurs early, resolves by age

Background § TLK 50% children with achondroplasia 1 § Occurs early, resolves by age 3 in 60 -70% 2, 3 § 11 -15% beyond age 10 – neurologic symptoms requiring surgical intervention 4, 5 § Risk factors for progression; – High TLK – Apical vertebral wedging – Developmental delay 2, 6

Purpose § To define spinopelvic in children with achondroplasia and determine if these parameters

Purpose § To define spinopelvic in children with achondroplasia and determine if these parameters may be predictive of persistent progressive TLK in children with achondroplasia

Methods 300 children 2004 -2015 Minimum 2 year radiographic follow-up One standing lateral radiograph

Methods 300 children 2004 -2015 Minimum 2 year radiographic follow-up One standing lateral radiograph after age 10 Excluded postoperative radiographs Measured: Thoracolumbar kyphosis (T 10/L 2), Thoracic Kyphosis, Lumbar Lordosis, Pelvic Incidence (PI)

Methods Two groups identified; • Final TLK ≥ 20 or <20 degrees Outcomes: •

Methods Two groups identified; • Final TLK ≥ 20 or <20 degrees Outcomes: • Evolution of measurements within each group • Comparison to detect potential risk factors for a high TLK after ten years of age.

Results 64 children 22 (31%) had TLK ≥ 20. Mean age at the first

Results 64 children 22 (31%) had TLK ≥ 20. Mean age at the first and last evaluations was 10. 8 and 16. 7 years None of their measurements changed significantly over a mean followup 5. 9 years (2. 1 -8. 9 years) except for TPA and SVA that were in clinically acceptable limits. 44 (69%) had TLK <20. Age at the first and last evaluations was 8. 2 and 14. 2 years. TLK was the only parameter that changed significantly (decreased) over a mean of 6 years (210. 1 years).

Results TLK ≥ 2: No measurements changed over mean followup 5. 9 years (2.

Results TLK ≥ 2: No measurements changed over mean followup 5. 9 years (2. 1 -8. 9) TLK <20: TLK only parameter that changed (decreased) over mean 6 years (2 -10. 1).

Results A comparison between the two groups showed that for children who had a

Results A comparison between the two groups showed that for children who had a high final TLK, initial TLK was significantly higher and PI was significantly lower.

Conclusions After ten years of age, TLK did not show improvement over time. Lower

Conclusions After ten years of age, TLK did not show improvement over time. Lower PI was associated with high TLK. Emphasizes the importance of early radiographic follow up for thoracolumbar deformity in children with achondroplasia. Once children have increased TLK after age ten, the deformity is likely to remain, and assessment of pelvic parameters is important.

References 1. 2. 3. 4. 5. 6. Engberts AC, Jacobs WCH, Castelijns SJAM, Castelein

References 1. 2. 3. 4. 5. 6. Engberts AC, Jacobs WCH, Castelijns SJAM, Castelein RM, Vleggeert. Lankamp CLA. The prevalence of thoracolumbar kyphosis in achondroplasia: a systematic review. J Child Orthop. 2012; 6(1): 69 -73. doi: 10. 1007/s 11832 -011 -0378 -7. Kopits SE. Thoracolumbar kyphosis and lumbosacral hyperlordosis in achondroplastic children. Basic Life Sci. 1988; 48: 241 -255. Borkhuu B, Nagaraju DK, Chan G, Holmes LJ, Mackenzie WG. Factors related to progression of thoracolumbar kyphosis in children with achondroplasia: a retrospective cohort study of forty-eight children treated in a comprehensive orthopaedic center. Spine. 2009; 34(16): 1699 -1705. doi: 10. 1097/BRS. 0 b 013 e 3181 ac 8 f 9 d. Pauli RM, Breed A, Horton VK, Glinski LP, Reiser CA. Prevention of fixed, angular kyphosis in achondroplasia. J Pediatr Orthop. 1997; 17(6): 726 -733. Lonstein JE. Treatment of kyphosis and lumbar stenosis in achondroplasia. Basic Life Sci. 1988; 48: 283 -292. Borkhuu B, Nagaraju DK, Chan G, Holmes LJ, Mackenzie WG. Factors related to progression of thoracolumbar kyphosis in children with achondroplasia: a retrospective cohort study of forty-eight children treated in a comprehensive orthopaedic center. Spine. 2009; 34(16): 1699 -1705. doi: 10. 1097/BRS. 0 b 013 e 3181 ac 8 f 9 d.