Congenital Kyphosis



Kyphosis due to congenitally anomalous vertebrae

- characterized by severe angular deformity

- prominent gibbus at the apex of the curve




Type I - Failure of formation


Failure formation anteriorly + preservation of posterior elements

- hemivertebrae / wedge vertebrae

- most common

- produces the worst deformity

- NHx is one of relentless progression

- 7per year

- most likely to result in paraplegia


Congenital Kyphosis XrayCongenital Kyphosis CT


Type II - Failure of segmentation


Anterior unsegmented bar

- better prognosis

- produces more rounded kyphosis

- deformity progresses more slowly

- paraplegia is uncommon


Type III


Mixed pattern


Clinical Features


Severe deformity maybe obvious at birth

- less obvious deformities may not appear until later

- may be accentuated during adolescent growth spurt


Progression occurs to end of growth & often after growth complete




Due to

- growth differential

- erosion of vertebral body from mechanical pressure




Deformity can become very severe (Type I)

- breakdown of the overlying soft tissues

- compression of abdominal viscera

- impairment of pulmonary function


Paraplegia may occur (Type I)




Non operative not effective


Work up


MRI / Neurosurgery

- exclude intraspinal pathology



- cardiac abnormality


Abdominal US

- renal abnormality




Type I


Ideal treatment is early detection & early posterior fusion

- best results if fusion by age 3

- can be done as early as 6/12


A.  < 5 years & curve < 50o

- posterior spinal fusion


B.  > 5 years and > 500

- anterior and posterior fusion


C.  Neurology

- anterior decompression first


Congenital Kyphosis CTCongenital Kyphosis Correction Lateral


Type II 


If early, can treat with anterior osteotomy of unsegmented bar

- i.e. epiphyseolysis


If late, requires posterior fusion