Post-traumatic kyphosis. A review of forty-eight surgically treated patients

We reviewed the cases of forty-eight patients who were treated surgically for symptomatic post-traumatic kyphosis of the thoracic or lumbar spine six months or longer after the initial injury. Presenting signs and symptoms included pain in 94 per cent, progression of kyphosis in 46 per cent, instability in 36 per cent, and increasing neural deficit in 27 per cent. Twenty-four patients had had a prior laminectomy. Posterior fusion (sixteen patients) and combined anterior and posterior fusion (twenty patients) always resulted in primary fusion. Anterior fusion alone was attempted in twelve patients, but failed in six. The average final correction of the deformity was 26 per cent. Pain was reduced significantly in 31 per cent of the patients and was relieved completely in 67 per cent. Fourteen of the forty-eight patients also had an anterior decompression, of whom five were neurologically improved, four were unchanged or stabilized, and four were immediately worse after operation. One patient was neurologically stable for twenty-three months postoperatively and then deteriorated again. No patients were neurologically improved following posterolateral decompression or repeat exploratory laminectomy.