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Closing-opening wedge osteotomy for thoracolumbar traumatic kyphosis.

Li X, Zhang J, Tang H, Lu Z, Chen S, Hong Y - Eur. J. Med. Res. (2014)

Bottom Line: Operation-associated complications were also recorded.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°).Three patients exhibited improved neurological function.

View Article: PubMed Central - PubMed

Affiliation: School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China. muzixiangxin@sina.com.

ABSTRACT

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.

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Related in: MedlinePlus

Radiographs of case 3. (A) Preoperative X-ray films. Left: Preoperative A-P film showed absence of posterior element at T11 level which indicated that laminectomy had been performed. Right: The lateral film showed anterior collapse of T11 vertebral body and local kyphosis of 36°. (B) Immediately postoperative X-ray films: A closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. The kyphotic angle was corrected to 10°. (C) Follow-up X-ray films: Bony fusion was achieved and there was only 2° of correction loss at 3 years follow-up.
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Fig1: Radiographs of case 3. (A) Preoperative X-ray films. Left: Preoperative A-P film showed absence of posterior element at T11 level which indicated that laminectomy had been performed. Right: The lateral film showed anterior collapse of T11 vertebral body and local kyphosis of 36°. (B) Immediately postoperative X-ray films: A closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. The kyphotic angle was corrected to 10°. (C) Follow-up X-ray films: Bony fusion was achieved and there was only 2° of correction loss at 3 years follow-up.

Mentions: This 30-year-old female patient sustained a T11 burst fracture (AO classification B1.2) in a motor vehicle accident with neurological deficit. She underwent posterior laminectomy without instrumentation as the initial treatment at another hospital. Kyphosis and back pain developed gradually after the surgery. When she came to our outpatient department 6 months after the initial injury, she complained of severe back pain and presented with T10 spinal cord injury (ASIA grade C). She could not stand and walk for any prolonged period because of back pain. The preoperative kyphotic angle was 36°. To correct the deformity, a closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. After surgery the local kyphosis improved to 4° and significant pain relief was noted. No significant loss of correction or implant failure was reported at 3 years follow-up. The neurological function improved from ASIA grade C preoperatively to grade D at final follow-up (Figure 1).Figure 1


Closing-opening wedge osteotomy for thoracolumbar traumatic kyphosis.

Li X, Zhang J, Tang H, Lu Z, Chen S, Hong Y - Eur. J. Med. Res. (2014)

Radiographs of case 3. (A) Preoperative X-ray films. Left: Preoperative A-P film showed absence of posterior element at T11 level which indicated that laminectomy had been performed. Right: The lateral film showed anterior collapse of T11 vertebral body and local kyphosis of 36°. (B) Immediately postoperative X-ray films: A closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. The kyphotic angle was corrected to 10°. (C) Follow-up X-ray films: Bony fusion was achieved and there was only 2° of correction loss at 3 years follow-up.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4231190&req=5

Fig1: Radiographs of case 3. (A) Preoperative X-ray films. Left: Preoperative A-P film showed absence of posterior element at T11 level which indicated that laminectomy had been performed. Right: The lateral film showed anterior collapse of T11 vertebral body and local kyphosis of 36°. (B) Immediately postoperative X-ray films: A closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. The kyphotic angle was corrected to 10°. (C) Follow-up X-ray films: Bony fusion was achieved and there was only 2° of correction loss at 3 years follow-up.
Mentions: This 30-year-old female patient sustained a T11 burst fracture (AO classification B1.2) in a motor vehicle accident with neurological deficit. She underwent posterior laminectomy without instrumentation as the initial treatment at another hospital. Kyphosis and back pain developed gradually after the surgery. When she came to our outpatient department 6 months after the initial injury, she complained of severe back pain and presented with T10 spinal cord injury (ASIA grade C). She could not stand and walk for any prolonged period because of back pain. The preoperative kyphotic angle was 36°. To correct the deformity, a closing-opening wedge osteotomy at T11 level and T9-L1 pedicle screw instrumentation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed. After surgery the local kyphosis improved to 4° and significant pain relief was noted. No significant loss of correction or implant failure was reported at 3 years follow-up. The neurological function improved from ASIA grade C preoperatively to grade D at final follow-up (Figure 1).Figure 1

Bottom Line: Operation-associated complications were also recorded.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°).Three patients exhibited improved neurological function.

View Article: PubMed Central - PubMed

Affiliation: School of Rehabilitation Medicine, Capital Medical University, Beijing, 100068, China. muzixiangxin@sina.com.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus