Pedicle subtraction osteotomies for the correction of post-traumatic thoracolumbar kyphosis

Department of Neurological Surgery, University of California San Francisco, 400 Parnassus Ave, Box 0350 San Francisco, California 94143-0350, USA.
Journal of Clinical Neuroscience (Impact Factor: 1.38). 11/2009; 17(1):113-7. DOI: 10.1016/j.jocn.2009.03.038
Source: PubMed

ABSTRACT Traumatic compression fractures are usually treated non-surgically. In most patients without osteoporosis, such fractures heal without any sequelae. However, some patients develop a post-traumatic kyphosis that can lead to severe pain and disability, refractory to non-surgical management. In such patients, correction of the kyphosis ultimately may be the only definitive treatment. Pedicle subtraction osteotomies have been used in non-traumatic settings to correct kyphotic deformities or restore lordosis in patients in symptomatic positive sagittal balance. We apply this technique in the setting of post-traumatic kyphosis, and we performed the osteotomies at the level of the compression fracture.

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    ABSTRACT: Fractures of the thoracolumbar junction can lead to regional kyphosis, this being a significant cause of pain and disability for the patients. After a traumatic fracture of the thoracolumbar spine, early or late regional kyphosis can be observed. This post-traumatic deformity can, however, be corrected with appropriate surgical methods. Posterior tricolumnar osteotomies are some of the most powerful methods of correction and are particularly indicated when sagittal and coronal deformities have to be simultaneously corrected or when anterior surgery is not possible. Anterior corpectomy and lengthening with posterior instrumentation are, however, an alternative technique to restore the anterior column support and to correct the regional kyphotic deformity and an option for appropriate sagittal balance restoration and control of symptoms. Proper surgical technique, evaluation of the bone quality and identification of eventual extension of the deformity to the thoracic spine are key aspects in prevention of failures.
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