Beneficial Effects of Surgical Treatment of Compressive Myelopathy in Patients With Severe Angular Kyphosis of Thoracolumbar Spine: A Retrospective Study of 12 Cases

Background: Severe angular kyphosis is one of the uncommon etiologies of compressive myelopathy and hence, many aspects of this myelopathy are unknown. Objectives: In this study, we report a series of 12 patients with compressive myelopathy in severe angular kyphosis, as well as the result of surgical treatment in these patients. Methods: In a retrospective study, we included 12 patients with the progressive or sudden onset of paraplegia caused by severe angular kyphosis. The neurological status of the patients was evaluated with the American Spinal Injury Association (ASIA) typing system before the operation and at four time points after the operation (1 day, 1 week, 6 months, 1 year). The main surgical interventions included anterior corpectomy, anterior spinal fusion, and posterior spinal fusion with or without instrumentation and with or without decompression. Results: The Mean±SD age of the patients was 41.9±16.4 years, ranging from 14 to 59 years. The etiology of myelopathy was congenital kyphosis in 10 patients (83.3%). The Mean±SD duration of paralysis was 6.4±6.6 months. The Mean±SD percentage of cord thinning at the apex was 61.7±17.5%. Bowel or bladder dysfunction was present in 6 patients (50%) before the surgery that was resolved in 5 patients after the surgery. One year after the surgery, the ASIA typing was improved in 9 patients (75%) and remained the same as preoperative status in 3 patients (25%). Conclusion: Surgical decompression corrects the neurological symptoms in the majority of cases with compressive myelopathy caused by severe angular kyphosis.