Correction of severe post-traumatic kyphosis by posterior vertebra column resection

Post-traumatic kyphosis is a common potential complication of spinal trauma and correct management of this problem is becoming ever more important. Although posterior vertebra column resection has been increasingly adopted to correct severe spinal deformity, no series of reports were found on severe post-traumatic kyphosis in the thoracolumbar region. Therefore, the present cohort retrospective study is presented to evaluate the clinical and radiographic results of posterior vertebra column resection with instrument fusion performed in patients with severe post-traumatic kyphosis.

From May 2004 to May 2006, 53 patients (38 male, 15 female) at an average age of 37.6 years (range, 24 to 66 years), were surgically treated for symptomatic post-traumatic thoracolumbar kyphosis with a posterior wedge closing osteotomy at our hospital. Among them, 5 consecutive adult patients with severe post-traumatic kyphosis were included in this study. Operation time, blood loss and complications were noted in each case. Radiographic documentation was made on the basis of standing anterior-posterior (AP) and lateral views and three dimensional reconstruction images of computed tomography (CT) scans were used to further identify the apex region of a sharp angular deformity. Sagittal correction was assessed in terms of effective regional deformity (ERD) for the injury level. Assessment of radiological fusion at follow-up was based on the presence of trabecular bone bridging at the osteotomy site according to Brantigan. Preoperative and postoperative clinical assessments were performed by using Oswestry disability index (ODI), back pain was rated in all patients by the visual analog scale (VAS) preoperatively, postoperatively and at the latest follow-up.

The mean operating time was 265 minutes (220 - 408 minutes), with an average blood loss of 1362 ml (870 - 2570 ml). Each patient finished at least two years of follow-up. The average ERD significantly decreased from 69 degrees (58 degrees - 86 degrees ), preoperatively to 4 degrees (1 degrees - 8 degrees ) after surgery (P = 0.017); with a mean correction of 65 degrees . ERD averaged 10.4 degrees (7 degrees - 17 degrees ) at the latest follow-up with a mean loss of 6.4 degrees . VAS and ODI scores improved from preoperative 7.4 (6.0 - 9.0) and 55.2 (48.0 - 60.0) to 2.3 (1.0 - 4.0) and 12.2 (7.0 - 18.0) at the latest follow-up. Full bone fusion was achieved in all patients. Complications occurred in two patients: one had a transient weakness of the left side lower extremity and the symptom improved spontaneously without further treatment within one month; the other patient suffered a deep wound infection three weeks after the operation, and recovered well by additional debridement, continuous perfusion and drainage.

Posterior vertebra column resection can satisfactorily correct severe post-traumatic kyphosis in thoracolumbar region. Nevertheless, this challenging procedure should be performed by experienced spinal surgeon to minimize complications.