Surgical correction of post-traumatic thoracolumbar kyphotic deformity with posterior transpedicular limited osteotomy technique

Objective: To evaluate the clinical outcome of surgical management for post-traumatic thoracolumbar kyphotic deformity with single-stage posterior transpedicularlimited osteotomies. Methods: From March 2007 to May 2010, 17 patients with post-traumatic thoracolumbar kyphotic deformity treated with posterior limited transpedicular osteotomy were admitted. The preoperative Cobb angle was 41°-62°(52.5°±6.4°). Sagittal balance was evaluated by the standing lateral films measuring the C₇ plumb line distance (C₇ PLD) from the posterior superior corner of S ₁. The C₇ PLD was 18-58 (41.2±12.4) mm in the sagittal plane. The preoperative oswestry disability index (ODI) was 42-50 (45.7±2.7), and the average preoperative visual analogue scale (VAS) was 8-10 (8.8±0.7). The American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological deficits, and grade C in 1 patient, grade D in 7 and grade E in 9 patients. The operation time, blood loss, complications, post-operative Cobb angle, ODI and VAS score at the follow-up were collected and analyzed.PLD was 18-58 (41.2±12.4) mm in the sagittal plane. The preoperative oswestry disability index (ODI) was 42-50 (45.7±2.7), and the average preoperative visual analogue scale (VAS) was 8-10 (8.8±0.7). The American Spinal Injury Association (ASIA) impairment scale was used to assess the neurological deficits, and grade C in 1 patient, grade D in 7 and grade E in 9 patients. The operation time, blood loss, complications, post-operative Cobb angle, ODI and VAS score at the follow-up were collected and analyzed. Results: The average duration of postoperative follow-up was 24-53 (34.5±7.l) months. The operation time was 180-400 (287.1±65.9) min, with an blood loss of 350-1 300 (838.2±276.4) mL. The postoperative kyphotic angle was 3°-12° (6.1°±3. 0°), and it was 7.5°±2.6° at the final follow-up evaluation. The postoperative C7PLD was (3.6±3.9) mm and it was (3.4±2.3) mm at the final follow-up evaluation. Postoperatively, the ASIA impairment scale was grade D in 4 and grade E in 13 patients. At the final follow-up ODI and VAS were reduced to an average of 5.2±2.4 and 2.4±1.0, respectively. Cerebrospinal fluid leakage was found in 2 patients, deep wound infection in 1, and intercostal neuralgia in 2. All the complications were relieved after conservative medical therapy. One patient received additional surgery at postoperative 12 weeks due to breakage of posterior implants. Another screw pullout case was treated with reinsertion of larger screws at postoperative 4 months. Solid fusion was confirmed by plain film and CT scan in all patients within 1 year after the surgery. Conclusion: Single-staged posterior transpedicular limited osteotomies is safe and effective to correct post-traumatic thoracolumbar kyphotic deformity.