The surgical treatment of post-traumatic vertebral deformities

The authors report their experience in the treatment of malunited fractures of the spine. After eliminating reducible lesions, the methods of treatment used for fixed irreducible lesions are described. In the cervical spine, the approach is anterior, and includes corporectomy to decompress the medullary canal. It is often impossible to restore cervical lordosis but this is not essential. In the dorsal, dorsolumbar and lumbar spines, experience has demonstrated the inadequacy of isolated anterior and posterior surgical approaches, so a combined approach is proposed aimed at achieving good results, both neurological and mechanical. Reconstruction of the vertebral body is carried out by anterior grafting using bank bone from femoral heads, while fixation is achieved posteriorly by the use of Roy-Camille plates. Indications are carefully considered, taking into account that progression is always a possibility in patients with no neurological deficit. The results are analysed in 14 cervical lesions and 10 dorsolumbar lesions. This operative treatment frequently produced stabilisation as well as the regression of pyramidal signs, but recovery of medullary lesions was never observed. The relief of pain, however, was a constant finding.