[Management of rigid post-traumatic thoracolumbar kyphosis by simultaneous posterior-anterior circumferential releasing and correction with preserved posterior vertebral wall].

OBJECTIVE: To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterior-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall.

METHODS: Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores.

RESULTS: No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 +/- 3.9) was significantly improved when compared with the pre-operative score (14.0 +/- 5.7) (t = 4.536, P = 0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilized time. The Cobb angle was corrected from (43.2 +/- 11.5) degrees preoperatively to (9.8 +/- 5.7) degrees at last follow-up, showing significant difference (P < 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P < 0.05). The intervertebral height of fractured vertebra was restored to 87.0% +/- 11.2% of adjacent disc height.

CONCLUSION: Posterior-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satisfactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.