Pedicle Disc Wedge Osteotomy for the Correction of Late Post-traumatic Thoracolumbar kyphosis

Abstract

Background Data: Late Post-traumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment. There are several surgical options to correct late post-traumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of clinical and radiological outcome success. Purpose: The aim of this study was to assess the use of a pedicle disc wedge osteotomy for the treatment of late post-traumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated by this technique. Study Design: A descriptive retrospective clinical case study. Patients and Methods: Ten consecutive patients with symptomatic post-traumatic thoracolumbar kyphosis were treated using a pedicle disc wedge osteotomy. The mean patient age was 37.5 years. The initial trauma in all patients was Type A3, A4 according to AOSPINE thoracolumbar trauma classification. The kyphosis apex ranged from T-12 to L-2. The sagittal alignment, kyphotic angle, neurological function, Visual Analog Scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. Results: The mean preoperative regional angle was 35.5°, and the mean correction angle was 28.5°. Sagittal alignment improved with a mean correction rate of 47%. The mean surgical time was 227 minutes, and the mean intraoperative blood loss was 1380 ml. The mean Visual Analog Score for back pain improved from 8.2 to 2.0, and the Oswestry Disability Index score decreased from 56.4 to 24.4 at the last follow-up. All patients achieved bony fusion based on the presence of trabecular bone bridging at the osteotomy site. Conclusion: The pedicle disc wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion. (2017ESJ139)

Keywords

• Thoracolumbar fracture
• posttraumatic thoracolumbar kyphosis
• pedicle disc wedge osteotomy
• deformity