Case ReportBrace treatment of thoracolumbar kyphosis in spondylometaphyseal dysplasia with restoration of vertebral morphology and sagittal profile: a case report

Background contextThe Kozlowski type of spondylometaphyseal dysplasia (SMD-K) is characterized by vertebral and metaphyseal abnormalities. The longitudinal evolution of thoracolumbar kyphosis associated with vertebral anomalies in SMD-K is unclear.PurposeTo document the longitudinal changes in sagittal alignment and vertebral morphology in a patient with SMD-K treated nonoperatively with a Milwaukee brace.Study design/settingCase report.Patient samplePatient with SMD-K having multiple vertebral anomalies and a thoracolumbar kyphosis.MethodsA girl with SMD-K seen initially at 21 months old was followed for 14 years. She presented with thoracolumbar kyphosis associated with multiple vertebral anomalies consisting primarily of hypoplasia at L1, beaking at L2, and ovoid shape of adjacent vertebrae. The patient was treated with a Milwaukee brace and followed until she was 16 years old.ResultsAfter initiation of brace treatment, the thoracolumbar kyphosis gradually resolved and she had a normal sagittal alignment at last follow-up. Normal vertebral morphology was also completely restored in the sagittal plane. The patient developed a main thoracic scoliosis that did not require additional treatment.ConclusionsNonoperative treatment with bracing can be attempted in patients with SMD-K affected by thoracolumbar kyphosis and multiple vertebral anomalies, because full restoration of normal sagittal alignment and vertebral morphology is possible.