Four-level pedicle subtraction osteotomy for severe rigid thoracic hyperkyphosis: a technical case report

Area of Science:

• Spine surgery
• Orthopedics
• Neurosurgery

Background:

• Severe thoracic hyperkyphosis from osteoporotic fractures causes significant disability.
• Rigid deformities often necessitate surgical intervention.
• This report details a rare case of four-level pedicle subtraction osteotomy (PSO).

Purpose of the Study:

• To describe the technique, outcomes, and complications of a four-level PSO.
• To evaluate the efficacy of PSO for severe, rigid thoracic hyperkyphosis in osteoporotic patients.
• To highlight the importance of careful planning and staged correction.

Main Methods:

• Technical case report of a 65-year-old female with Scheuermann's disease and osteoporotic fractures.
• Two-stage surgery: cement-augmented instrumentation (T2-L3) followed by contiguous PSOs (T6-T9).
• Continuous neurophysiological monitoring was employed throughout the procedure.

Main Results:

• Kyphosis corrected from 130.3° to 48°.
• Postoperative spinal cord kinking led to lower limb weakness, requiring revision surgery with neurological recovery.
• Two-year follow-up showed stable radiological parameters, reduced pain, improved mobility, and restored quality of life.

Conclusions:

• Four-level PSO is an effective treatment for severe, rigid thoracic hyperkyphosis in osteoporotic individuals.
• The procedure is technically demanding and carries risks of complications.
• Staged correction and meticulous planning are crucial for successful outcomes.