by MICHAEL J. MCMASTER, and HARWANT SINGH

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by MICHAEL J. MCMASTER, and HARWANT SINGH Natural History of Congenital Kyphosis and Kyphoscoliosis. A Study of One Hundred and Twelve Patients* by MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am Volume 81(10):1367-83 October 1, 1999 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 1 Histogram showing the number of patients who had each type of congenital kyphosis and kyphoscoliosis and the ages of the patients at the time of diagnosis. Fig. 1 Histogram showing the number of patients who had each type of congenital kyphosis and kyphoscoliosis and the ages of the patients at the time of diagnosis. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 2 Drawings showing the different types of vertebral anomalies that produce a congenital kyphosis or kyphoscoliosis. Fig. 2 Drawings showing the different types of vertebral anomalies that produce a congenital kyphosis or kyphoscoliosis. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 3 Graph showing the different types of vertebral defects as well as the number of vertebral levels affected. Fig. 3 Graph showing the different types of vertebral defects as well as the number of vertebral levels affected. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-A Anteroposterior and lateral radiographs of a five-month-old infant, showing a type-I thoracolumbar kyphoscoliosis due to a posterolateral quadrant vertebra at the first lumbar level. Fig. 4-A Anteroposterior and lateral radiographs of a five-month-old infant, showing a type-I thoracolumbar kyphoscoliosis due to a posterolateral quadrant vertebra at the first lumbar level. The kyphosis measured 38 degrees and the scoliosis, 45 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-B Anteroposterior and lateral radiographs of a five-month-old infant, showing a type-I thoracolumbar kyphoscoliosis due to a posterolateral quadrant vertebra at the first lumbar level. Fig. 4-B Anteroposterior and lateral radiographs of a five-month-old infant, showing a type-I thoracolumbar kyphoscoliosis due to a posterolateral quadrant vertebra at the first lumbar level. The kyphosis measured 38 degrees and the scoliosis, 45 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-C Anteroposterior and lateral radiographs, made when the child was nine years and seven months old, showing a sharp angular deformity. Fig. 4-C Anteroposterior and lateral radiographs, made when the child was nine years and seven months old, showing a sharp angular deformity. The kyphosis had increased to 60 degrees and the scoliosis, to 58 degrees. The congenital anomaly is seen on both radiographs. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 4-D Anteroposterior and lateral radiographs, made when the child was nine years and seven months old, showing a sharp angular deformity. Fig. 4-D Anteroposterior and lateral radiographs, made when the child was nine years and seven months old, showing a sharp angular deformity. The kyphosis had increased to 60 degrees and the scoliosis, to 58 degrees. The congenital anomaly is seen on both radiographs. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-A Anteroposterior and lateral radiographs of a child, seven years and seven months old, showing a type-I caudad thoracic kyphoscoliosis due to a butterfly vertebra at the tenth thoracic level. Fig. 5-A Anteroposterior and lateral radiographs of a child, seven years and seven months old, showing a type-I caudad thoracic kyphoscoliosis due to a butterfly vertebra at the tenth thoracic level. The kyphosis measured 30 degrees and the scoliosis, 21 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-B Anteroposterior and lateral radiographs of a child, seven years and seven months old, showing a type-I caudad thoracic kyphoscoliosis due to a butterfly vertebra at the tenth thoracic level. Fig. 5-B Anteroposterior and lateral radiographs of a child, seven years and seven months old, showing a type-I caudad thoracic kyphoscoliosis due to a butterfly vertebra at the tenth thoracic level. The kyphosis measured 30 degrees and the scoliosis, 21 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-C Anteroposterior and lateral radiographs, made when the patient was sixteen years and eight months old, showing that the kyphosis had increased to 56 degrees and the scoliosis, to 46 degrees. Fig. 5-C Anteroposterior and lateral radiographs, made when the patient was sixteen years and eight months old, showing that the kyphosis had increased to 56 degrees and the scoliosis, to 46 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 5-D Anteroposterior and lateral radiographs, made when the patient was sixteen years and eight months old, showing that the kyphosis had increased to 56 degrees and the scoliosis, to 46 degrees. Fig. 5-D Anteroposterior and lateral radiographs, made when the patient was sixteen years and eight months old, showing that the kyphosis had increased to 56 degrees and the scoliosis, to 46 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-A: Lateral radiograph of a two-year-old child, showing a type-II thoracolumbar kyphosis due to an anterior unsegmented bar between the twelfth thoracic and the first lumbar vertebra. Fig. 6-A: Lateral radiograph of a two-year-old child, showing a type-II thoracolumbar kyphosis due to an anterior unsegmented bar between the twelfth thoracic and the first lumbar vertebra. The kyphosis measured 20 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-B: Lateral radiograph, made when the child was twelve years and nine months old, showing that the kyphosis had increased to 23 degrees. Fig. 6-B: Lateral radiograph, made when the child was twelve years and nine months old, showing that the kyphosis had increased to 23 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 6-C Lateral radiograph, made when the patient was seventeen years and five months old, showing that there had been very little deterioration and that the kyphosis had increased to 27 degrees. Fig. 6-C Lateral radiograph, made when the patient was seventeen years and five months old, showing that there had been very little deterioration and that the kyphosis had increased to 27 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-A Anteroposterior and lateral radiographs of a child, six years and eight months old, showing a type-III thoracolumbar kyphoscoliosis due to mixed anomalies. Fig. 7-A Anteroposterior and lateral radiographs of a child, six years and eight months old, showing a type-III thoracolumbar kyphoscoliosis due to mixed anomalies. There is an anterolateral unsegmented bar extending from the twelfth thoracic to the third lumbar vertebra and a posterolateral quadrant vertebra at the second lumbar level. The kyphosis measured 55 degrees and the scoliosis, 59 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-B Anteroposterior and lateral radiographs of a child, six years and eight months old, showing a type-III thoracolumbar kyphoscoliosis due to mixed anomalies. Fig. 7-B Anteroposterior and lateral radiographs of a child, six years and eight months old, showing a type-III thoracolumbar kyphoscoliosis due to mixed anomalies. There is an anterolateral unsegmented bar extending from the twelfth thoracic to the third lumbar vertebra and a posterolateral quadrant vertebra at the second lumbar level. The kyphosis measured 55 degrees and the scoliosis, 59 degrees. No treatment was given. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-C Anteroposterior and lateral radiographs, made when the child was eleven years and two months old, showing that the kyphosis had increased to 86 degrees and the scoliosis, to 70 degrees. Fig. 7-C Anteroposterior and lateral radiographs, made when the child was eleven years and two months old, showing that the kyphosis had increased to 86 degrees and the scoliosis, to 70 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 7-D Anteroposterior and lateral radiographs, made when the child was eleven years and two months old, showing that the kyphosis had increased to 86 degrees and the scoliosis, to 70 degrees. Fig. 7-D Anteroposterior and lateral radiographs, made when the child was eleven years and two months old, showing that the kyphosis had increased to 86 degrees and the scoliosis, to 70 degrees. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.

Fig. 8 Histogram showing the level of the apex of the congenital kyphosis or kyphoscoliosis in the 112 patients and the number of patients who had a spontaneous neurological deficit. Fig. 8 Histogram showing the level of the apex of the congenital kyphosis or kyphoscoliosis in the 112 patients and the number of patients who had a spontaneous neurological deficit. MICHAEL J. MCMASTER, and HARWANT SINGH J Bone Joint Surg Am 1999;81:1367-83 ©1999 by The Journal of Bone and Joint Surgery, Inc.