Posterior Vertebral Column Resection in Management of Severe Post-traumatic Thoracolumbar Kyphosis

Abstract

Background Data: Thoracolumbar fractures nowadays are considered the commonest spinal fractures and its treatment remains one of the major controversies. Post-traumatic kyphosis (PTK) is considered the commonest serious complication of poorly managed thoracolumbar fractures which can affect the patient health quality of life. Different corrective osteotomy techniques are described to correct this deformity but with limited correction in sever angular kyphotic deformity. Our hypothesis was, among several osteotomies described to correct kyphosis, vertebral column resection (VCR) provides the highest angle of correction required to manage patients with severe PTK.Purpose: To evaluate the safety and efficacy of posterior VCR in the treatment of patients with severe degrees of post-traumatic thoracolumbar kyphosis and determine the degree of correction in sagittal imbalance and its relationship with functional outcome of the patients. Study Design: This prospective clinical case study. Patients and Methods: Twelve patients suffering from PTK and managed with posterior VCR were recruited for this study. The mean local kyphosis angle (LKA) was 64.1±6.3 ᴼ . Outcome measures were Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) and radiological using local kyphosis angle (LKA), global kyphosis (GK), lumbar lordosis (LL) and sagittal vertical axis (SVA). The mean follow up time was 13.5±2 months.Results: The mean LKA and SVA score improved from 64.1± 6.3 o and 52.6±8.3mm preoperatively to 8.8±3.4 o and 13.1±4.8mm postoperatively, respectively. All were statistically significant. Functionally, the VAS score of back pain significantly reduced from 6.8±0.9 to 1.7±0.8 and the Oswestry Disability Index significantly improved from 59.8±7.5 to 11.6±3.4. No major complications were reported apart from intraoperative dural tear in 2 patients, superficial infection in one patient, deep infection in one patient and temporary paraparesis in one patient.Conclusion: Posterior VCR can provide satisfactory correction in severe PTK and improvement in functional outcome with appropriate application and fine surgical technique. (2018ESJ165)

The Current Status of Spinal Posttraumatic Deformity: A Systematic Review

“… 30 El Nagger et al only included patients in his study with severe SPTD and back pain affecting quality of life defined as a VAS>5 and an ODI >40. 66 …”

“…Refractory pain or increasing pain after conservative therapy was described in 9 articles. 27 , 29 , 30 , 43 , 52 , 53 , 61 , 63 , 66 Nineteen articles considered a progressive neurological deficit an absolute indication for surgical intervention. Progression can result from tension on the spinal cord, stenosis or a syrinx.…”

“…Some articles addressed this by using the Sagittal Index, the SRS-criteria or the Effective Regional Deformity. 28 , 30 , 31 , 47 , 61 , 65 - 67 …”

“…Some articles addressed this by using the Sagittal Index, the SRS-criteria or the Effective Regional Deformity. 28,30,31,47,61,[65][66][67] Spinopelvic parameters are of great importance to assess the spine and are extensively studied in the context of degenerative spine diseases as opposed to the context of a traumatic spine. Already, the use of various spinopelvic parameters in Adult Spinal Deformity is encouraged for surgical planning.…”