[Transpedicular osteotomy with dorsal wedge osteotomy: treatment of post-traumatic or postinfection kyphotic malalignment of the thoraco-lumbar spine]

[Pedicle subtraction osteotomy to correct rigid deformities]

OBJECTIVE

The aim of the surgery is to restore the sagittal profile in the event of a mismatch of the patient's spinopelvic parameters and high patient suffering.

INDICATIONS

Clinically symptomatic sagittal imbalance due to degeneration, trauma or after spinal surgery which can not be adequately treated by conservative therapy.

CONTRAINDICATIONS

Severe general disease of the patient; local or systemic inflammation.

SURGICAL TECHNIQUE

A dorsal approach is used to resect the dorsal vertebral structures and to perform an osteotomy to the anterior edge of the spine.

POSTOPERATIVE MANAGEMENT

Rest with a load limit of 5 kg for 3 months. Prohibition of deep sitting for this time.

RESULTS

The pedicle subtraction osteotomy is described in the literature as a reliable method for the treatment of sagittal imbalance. The high rate of described complications should be discussed preoperatively with the patient.

Closing-opening wedge osteotomy for thoracolumbar traumatic kyphosis

Background

Surgical treatment modalities for post-traumatic kyphosis (PTK) remain controversial. Like vertebral column resection, closing-opening wedge osteotomy (COWO) can achieve satisfactory results for kyphosis with multiple etiologies. However, few studies have assessed this procedure for PTK. Our purpose was to evaluate the radiographic and clinical outcomes of COWO in a selected series of patients with PTK via a single posterior approach.

Methods

In this retrospective case series, seven patients with symptomatic PTK in the thoracolumbar spine were reviewed. Five patients underwent surgery at the time of initial injury, and the other two initially underwent conservative treatment. All seven patients underwent COWO procedures through a single posterior approach. The Cobb angle was assessed preoperatively, postoperatively, and at the final follow-up. A visual analog scale (VAS) and the American Spinal Injury Association scale were used to evaluate back pain and neurological function preoperatively and at final follow-up, respectively. Operation-associated complications were also recorded.

Results

The mean follow-up period was 34.3 months (range, 24 to 43 months). The mean kyphotic angle was significantly (P <0.05) reduced from 57.7° (range, 36° to 100°) preoperatively to 8° postoperatively (range, −12° to 50°). The mean VAS improved from 5.9 to 2.1 (P <0.05). Three patients exhibited improved neurological function. Bony fusion was achieved in all patients. No significant correction loss or permanent complication was noted.

Conclusions

Though technically demanding, COWO via a single posterior approach can provide satisfactory outcomes for selected patients with PTK. Additional studies are required to improve patient selection and outcomes for this condition.

Posterior Surgery Alone in the Treatment of Post-traumatic Kyphosis by Posterior Column Osteotomy, Spondylodesis, Instrumentation, and Vertebroplasty

Study Design

Retrospective study.

Purpose

To determine if posterior surgery alone can satisfactorily treat post-traumatic kyphosis (PTK).

Overview of Literature

One of the worst complications of vertebral fractures is PTK. The type of surgery and approach to treat a symptomatic and refractory PTK is a challenging issue in spinal surgery, and yet, there is no specific treatment algorithm.

Methods

From August 2003 to September 2010, we collected 26 cases (male to female ratio, 2.25; mean age, 31.9±9.7 years and follow-up period of 42.4±8.1 months) with PTK treated by posterior column osteotomy, spondylodesis, instrumentation and cement vertebroplasty in one stage posterior surgery. PTK angle, Oswestry Disability Index (ODI), visual analogue scale (VAS), and subjective satisfaction from surgery were used to determine the results. We used a student t test for analyzing the data before and after surgery.

Results

In our patients, T11 and L1 had the highest incidence of vertebral fractures. The results indicated that in PTK, ODI, and VAS were significantly improved this surgery. Solid fusion occurred in 96.2% of patients with 3.2°±2.1° loss of correction. A total of 84.6% of patients have satisfaction level of excellent and good.

Conclusions

Posterior surgery alone with posterior column osteotomy, vertebroplasty, posterior spinal fusion and instrumentation can effectively treat symptomatic PTK.