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Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.
J Neurosurg Spine. 2015 Oct; 23(4):510-7.JN

Abstract

OBJECT

Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique.

METHODS

Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27.4°, and the mean correction angle was 29.6°. Sagittal alignment improved with a mean correction rate of 58.3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55.4 to 22.6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site.

CONCLUTIONS

The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.

Authors+Show Affiliations

Departments of 1 Neurosurgery and.Department of Neurosurgery, Spine Center, Good Medical Hospital, Guri; and.Departments of 1 Neurosurgery and.Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul;Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26140402

Citation

Jo, Dae-Jean, et al. "Clinical and Radiological Outcomes of Modified Posterior Closing Wedge Osteotomy for the Treatment of Posttraumatic Thoracolumbar Kyphosis." Journal of Neurosurgery. Spine, vol. 23, no. 4, 2015, pp. 510-7.
Jo DJ, Kim YS, Kim SM, et al. Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Neurosurg Spine. 2015;23(4):510-7.
Jo, D. J., Kim, Y. S., Kim, S. M., Kim, K. T., & Seo, E. M. (2015). Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. Journal of Neurosurgery. Spine, 23(4), 510-7. https://doi.org/10.3171/2015.1.SPINE131011
Jo DJ, et al. Clinical and Radiological Outcomes of Modified Posterior Closing Wedge Osteotomy for the Treatment of Posttraumatic Thoracolumbar Kyphosis. J Neurosurg Spine. 2015;23(4):510-7. PubMed PMID: 26140402.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. AU - Jo,Dae-Jean, AU - Kim,Yong-Sang, AU - Kim,Sung-Min, AU - Kim,Ki-Tack, AU - Seo,Eun-Min, Y1 - 2015/07/03/ PY - 2015/7/4/entrez PY - 2015/7/4/pubmed PY - 2016/1/1/medline KW - AIS = American Spinal Injury Association Impairment Scale KW - AP = anteroposterior KW - ODI = Oswestry Disability Index KW - SPO = Smith-Petersen osteotomy KW - VAS = visual analog scale KW - deformity KW - modified posterior closing wedge osteotomy KW - posttraumatic thoracolumbar kyphosis KW - thoracolumbar fracture SP - 510 EP - 7 JF - Journal of neurosurgery. Spine JO - J Neurosurg Spine VL - 23 IS - 4 N2 - OBJECT: Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique. METHODS: Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27.4°, and the mean correction angle was 29.6°. Sagittal alignment improved with a mean correction rate of 58.3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55.4 to 22.6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site. CONCLUTIONS: The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis. SN - 1547-5646 UR - https://www.unboundmedicine.com/medline/citation/26140402/Clinical_and_radiological_outcomes_of_modified_posterior_closing_wedge_osteotomy_for_the_treatment_of_posttraumatic_thoracolumbar_kyphosis_ L2 - https://thejns.org/doi/10.3171/2015.1.SPINE131011 DB - PRIME DP - Unbound Medicine ER -