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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 and photographs of case 7. (A) Sagittal computed tomography scan of the initial injury showed dislocation at L1/L2 levels and significant comminution of the L1 vertebral body. (B) Preoperative lateral X-ray film: Collapse of the anterior column after implant removal and local kyphosis of 52°. (C) Preoperative MRI T2-weighted film. Intraoperative photographs of thoracolumbar spine before (D) and after (E) correction. (F) Immediately postoperative lateral radiograph: The kyphosis was corrected to 12°. (G) Lateral film at 2-year follow-up: Good maintenance of the correction and 4° of correction loss was noted. (H) Computed tomography scan at 2-year follow-up: Solid bony intervertebral fusion was achieved.
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Fig3: Radiographs and photographs of case 7. (A) Sagittal computed tomography scan of the initial injury showed dislocation at L1/L2 levels and significant comminution of the L1 vertebral body. (B) Preoperative lateral X-ray film: Collapse of the anterior column after implant removal and local kyphosis of 52°. (C) Preoperative MRI T2-weighted film. Intraoperative photographs of thoracolumbar spine before (D) and after (E) correction. (F) Immediately postoperative lateral radiograph: The kyphosis was corrected to 12°. (G) Lateral film at 2-year follow-up: Good maintenance of the correction and 4° of correction loss was noted. (H) Computed tomography scan at 2-year follow-up: Solid bony intervertebral fusion was achieved.

Mentions: This 20-year-old male patient suffered a fracture and dislocation at L1/2 segments in a falling injury. The neurological status was T10 spinal cord injury (ASIA grade C) at initial injury. He was treated with posterior long-segment pedicle instrumentation immediately after injury in another hospital. Unfortunately, uncontrolled deep wound infection occurred one month after the surgery, which made it necessary to remove all the implant and perform debridement and irrigation. Finally, the wound healed, but the collapse and kyphosis at the injury level developed progressively. When the patient was admitted to our ward at 16 months after the initial injury, he presented with deterioration of the neurological function (ASIA grade B) and severe back pain, which influenced normal sitting position and rehabilitation. A closing-opening wedge osteotomy at T12/L1 levels and T9-L4 pedicle screw fixation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed to correct the kyphotic deformity. The kyphosis improved from 52° preoperatively to 12° postoperatively and had 4° of loss of correction at 2-year follow-up. The neurological function improved from ASIA grade B preoperatively to ASIA grade C and significant pain relief was also noted at final follow-up (Figure 3).Figure 3


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 and photographs of case 7. (A) Sagittal computed tomography scan of the initial injury showed dislocation at L1/L2 levels and significant comminution of the L1 vertebral body. (B) Preoperative lateral X-ray film: Collapse of the anterior column after implant removal and local kyphosis of 52°. (C) Preoperative MRI T2-weighted film. Intraoperative photographs of thoracolumbar spine before (D) and after (E) correction. (F) Immediately postoperative lateral radiograph: The kyphosis was corrected to 12°. (G) Lateral film at 2-year follow-up: Good maintenance of the correction and 4° of correction loss was noted. (H) Computed tomography scan at 2-year follow-up: Solid bony intervertebral fusion was achieved.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Radiographs and photographs of case 7. (A) Sagittal computed tomography scan of the initial injury showed dislocation at L1/L2 levels and significant comminution of the L1 vertebral body. (B) Preoperative lateral X-ray film: Collapse of the anterior column after implant removal and local kyphosis of 52°. (C) Preoperative MRI T2-weighted film. Intraoperative photographs of thoracolumbar spine before (D) and after (E) correction. (F) Immediately postoperative lateral radiograph: The kyphosis was corrected to 12°. (G) Lateral film at 2-year follow-up: Good maintenance of the correction and 4° of correction loss was noted. (H) Computed tomography scan at 2-year follow-up: Solid bony intervertebral fusion was achieved.
Mentions: This 20-year-old male patient suffered a fracture and dislocation at L1/2 segments in a falling injury. The neurological status was T10 spinal cord injury (ASIA grade C) at initial injury. He was treated with posterior long-segment pedicle instrumentation immediately after injury in another hospital. Unfortunately, uncontrolled deep wound infection occurred one month after the surgery, which made it necessary to remove all the implant and perform debridement and irrigation. Finally, the wound healed, but the collapse and kyphosis at the injury level developed progressively. When the patient was admitted to our ward at 16 months after the initial injury, he presented with deterioration of the neurological function (ASIA grade B) and severe back pain, which influenced normal sitting position and rehabilitation. A closing-opening wedge osteotomy at T12/L1 levels and T9-L4 pedicle screw fixation (CD HORIZON, Medtronic, Minneapolis, MN, USA) and fusion were performed to correct the kyphotic deformity. The kyphosis improved from 52° preoperatively to 12° postoperatively and had 4° of loss of correction at 2-year follow-up. The neurological function improved from ASIA grade B preoperatively to ASIA grade C and significant pain relief was also noted at final follow-up (Figure 3).Figure 3

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