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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 4. (A) Preoperative X-ray films. Left: A-P film showed scoliosis of 20°. Right: Lateral film showed significant collapse of L1 vertebral body and kyphosis of 100°. (B) Sagittal computed tomography scan preoperative. (C) Postoperative X-ray films. Vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4 were performed. Left: Lateral film. Kyphosis was corrected to 50°. Right: A-P film. Scoliosis was corrected to 10°.
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Fig2: Radiographs of case 4. (A) Preoperative X-ray films. Left: A-P film showed scoliosis of 20°. Right: Lateral film showed significant collapse of L1 vertebral body and kyphosis of 100°. (B) Sagittal computed tomography scan preoperative. (C) Postoperative X-ray films. Vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4 were performed. Left: Lateral film. Kyphosis was corrected to 50°. Right: A-P film. Scoliosis was corrected to 10°.

Mentions: This 57-year-old male patient, according to his own personal statement, sustained a falling injury when he was 3 years old but did not receive any treatment due to economic problems. The kyphotic deformity of lumbar spine developed progressively. When he came to our outpatient clinic, he presented with severe cosmetic problems in the lumbar spine and weakness of bilateral iliopsoas and quadriceps. The preoperative pain was graded as 7, which influenced his normal sleep. The preoperative X-ray showed significant collapse of L2 segment and local kyphotic angle was 100°. The patient underwent vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4. After surgery, the kyphotic angle improved to 50° and pain relieved significantly. The patient experienced transient weakness of iliopsoas after surgery and recovered to preoperative status after 1 month of conservative treatment (Figure 2).Figure 2


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 4. (A) Preoperative X-ray films. Left: A-P film showed scoliosis of 20°. Right: Lateral film showed significant collapse of L1 vertebral body and kyphosis of 100°. (B) Sagittal computed tomography scan preoperative. (C) Postoperative X-ray films. Vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4 were performed. Left: Lateral film. Kyphosis was corrected to 50°. Right: A-P film. Scoliosis was corrected to 10°.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Radiographs of case 4. (A) Preoperative X-ray films. Left: A-P film showed scoliosis of 20°. Right: Lateral film showed significant collapse of L1 vertebral body and kyphosis of 100°. (B) Sagittal computed tomography scan preoperative. (C) Postoperative X-ray films. Vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4 were performed. Left: Lateral film. Kyphosis was corrected to 50°. Right: A-P film. Scoliosis was corrected to 10°.
Mentions: This 57-year-old male patient, according to his own personal statement, sustained a falling injury when he was 3 years old but did not receive any treatment due to economic problems. The kyphotic deformity of lumbar spine developed progressively. When he came to our outpatient clinic, he presented with severe cosmetic problems in the lumbar spine and weakness of bilateral iliopsoas and quadriceps. The preoperative pain was graded as 7, which influenced his normal sleep. The preoperative X-ray showed significant collapse of L2 segment and local kyphotic angle was 100°. The patient underwent vertebrectomy of L1 and L2 from posterior approach and one-step closing-opening wedge osteotomy with pedicle screws instrumentation (CDH + TSRH, Medtronic, Memphis, USA) from T9-L4. After surgery, the kyphotic angle improved to 50° and pain relieved significantly. The patient experienced transient weakness of iliopsoas after surgery and recovered to preoperative status after 1 month of conservative treatment (Figure 2).Figure 2

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