• Vibhu Krishnan Viswanathan, Ajoy Prasad Shetty, Rishi Mukesh Kanna, and S Rajasekaran.
• Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, 641043, India.
• Eur Spine J. 2022 Dec 1; 31 (12): 374337473743-3747.

PurposeTo discuss the effect of posterior instrumented deformity correction and fusion on the progressive endochondral ossification of anterior vertebral body in a patient with congenital kyphosis secondary to type 1 vertebral anomaly.MethodsA 15-year-old male patient presented with a progressively worsening congenital TL kyphosis of 52° magnitude secondary to a posterior hemivertebra. His pre-operative antero-posterior vertebral height ratio (APVHR) and anterior vertebral body defect ratio (AVBDR) on CT were 38% and 49%, respectively. He underwent posterior instrumented deformity correction with multilevel type 1 Schwab osteotomies and fusion.ResultsOver the next 3 years, his serial imaging revealed progressive endochondral ossification and gradual increase in the dimensions of the vertebral body. At the final follow-up, there was a significant restoration of the deficient anterior vertebral body, and the final APVHR and AVBDR were 81% and 90%, respectively.ConclusionsRestitution of posterior column integrity through stabilization can mitigate the compressive stresses across anterior column. Over a period of time, forces restraining the growth of anterior vertebral apophysis are alleviated, and the vertebra can potentially re-grow to near-normal dimensions in pediatric population. This phenomenon could be well-demonstrated in our patient during follow-up.Level Of Evidence IDiagnostic: individual cross-sectional studies with the consistently applied reference standard and blinding.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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