Management of late posttraumatic kyphosis with anterior Z-plate instrumentation

Failed treatment of thoracolumbar spine fractures may lead to late posttraumatic kyphosis (LPK), and LPK treatment is challenging. The aim of this retrospective study was to investigate whether anterior reduction and Z-plate instrumentation constitute feasible treatment for LPK (> 30 days after injury). Twenty patients who developed LPK after a thoracolumbar fracture were treated with the Z-plate anterior thoracolumbar plating system. Sixteen patients were followed for a mean of 35 months. Ten of 15 patients with a thoracotomy had persistent postthoracotomy pain. Mean back pain decreased significantly, from 9.2 before surgery to 4.1 after surgery (10 = worst pain ever experienced, 0 = no pain). Osseous union occurred in all patients. Postoperative loss of reduction of 4.9 degrees kyphotic angle was recorded at follow-up. Anterior stabilization with the Z-plate is a technically feasible procedure in patients with LPK. Long-term postthoracotomy pain seems to be a significant problem in these patients.