Super-Pedicle Osteotomy for Correction of Focal Thoracolumbar Kyphosis

Focal thoracolumbar kyphotic deformities require operative correction through osteotomies to restore normal spinal balance. Traditional osteotomies, such as the pedicle subtraction osteotomy, that are often used in the lumbar spine are less useful in the thoracolumbar region. The super-pedicle osteotomy is a pedicle-sparing wedge osteotomy that can be used for correction of kyphosis in patients with thoracolumbar deformities.

A retrospective review was conducted of 9 consecutive cases using the super-pedicle technique. Clinical data regarding patient age at presentation, etiology of deformity, symptoms, neurological status at presentation, American Society of Anesthesiologists class, type of surgery performed, estimated blood loss during surgery, and complications up to last follow-up were recorded. The primary parameter of interest was the angle at the planned osteotomy site before and after correction.

Nine patients with an average age of 64 years were included. All 9 patients had focal thoracic kyphosis either at T11-T12 or T12-L1. All patients underwent thoracolumbar operations with super-pedicle osteotomies at their main level of kyphosis. Estimated blood loss was 600 mL. Average correction at the osteotomy site as measured on preoperative and postoperative radiographs was 31°. At an average follow-up of 338 days, no patients experienced rod fracture, but 1 patient required extension of fusion for proximal junctional kyphosis.

In this small series of patients with thoracolumbar kyphosis, the super-pedicle osteotomy technique was clinically useful. More robust examination is required to determine the safety, utility, and durability of this osteotomy technique.