Background
Posttraumatic thoracolumbar deformity is a common complication of spinal trauma after conservative treatment or after inadequate surgical management. The goals of surgery are to decompress the neural elements and restore sagittal and coronal balance and to optimize the chances for successful fusion. These goals can be achieved through an all-anterior, all-posterior, or a combined anterior and posterior approach.
Patients and methods
A total of 13 patients with symptomatic posttraumatic thoracolumbar kyphosis were treated with pedicle subtraction osteotomy. The mean age of the patients was 35.3 years. The injury level was L1 in eight cases, L2 in three cases, and T12 in two cases. Of the 13 patients, eight had been managed conservatively and five had initial posterior pedicle screw fixation. Most patients (69.2%) complained of chronic and worsening pain in the thoracolumbar junction region, 38.4% were found to have progressive kyphosis, and none had conus or cauda neurologic impingement.
Results
The mean surgical time was 206 min, with a mean intraoperative blood loss of 700.7 ml. All patients completed follow-up for at least 2 years. Complications were encountered in six cases. The average Cobb angle decreased from 38.4° preoperatively to 2.3° after surgery. The mean visual analog scale for back pain decreased from 54.4 preoperatively to 18.5 at the last follow-up, and the Oswestry disability index score changed from a mean value of 53.07 preoperatively to 24.5 at the last follow-up. All patients achieved bony fusion based on the presence of trabecular bone bridging at the osteotomy site.
Conclusion
The pedicle subtraction osteotomy achieves satisfactory kyphosis correction and good fusion with less blood loss and complications than other approaches.