Pedicle subtraction osteotomy and disc resection with cage placement in post-traumatic thoracolumbar kyphosis, a retrospective study.

BACKGROUND: It is estimated that upwards of 50,000 individuals suffer traumatic fracture of the spine each year, and the instability of the fractured vertebra and/or the local deformity results in pain and, if kyphosis increases, neurological impairment can occur. There is a significant controversy over the ideal management. The purpose of the study is to present clinical and radiographic results of pedicle subtraction osteotomy and disc resection with cage placement in correcting post-traumatic thoracolumbar kyphosis.

METHODS: From May 2010 to May 2013, 46 consecutive patients experiencing post-traumatic thoracolumbar kyphosis underwent the technique of one-stage pedicle subtraction osteotomy and disc resection with cage placement and long-segment fixation. Pelvic incidence (PI), pelvic tilt (PT), sagittal vertical axis (SVA), and sagittal Cobb angle were measured to evaluate the sagittal balance. Oswestry disability index (ODI), visual analog scale (VAS), and general complications were recorded.

RESULTS: The average surgical time was 260 min (240-320 min). The mean intraoperative blood loss was 643 ml (400-1200 ml). The maximum correction angle was 58° with an average of 47°, and the SVA improved from +10.7 ± 3.5 cm (+7.2 to + 17.1 cm) to +4.1 ± 2.7 cm (+3.2 to + 7.6 cm) at final follow-up (p < 0.01). PT reduced from preoperative 27.2 ± 5.3° to postoperative 15.2 ± 4.7° (p < 0.01). The VAS changed from preoperative 7.8 ± 1.6 (5.0-9.0) to 3.2 ± 1.8 (2.0-5.0) (p < 0.01). Clinical symptoms and neurological function were significantly improved at the final follow-up. All patients completed follow-up of 41 months on average.

CONCLUSIONS: Pedicle subtraction osteotomy and disc resection with cage placement and long-segment fixation are effective and safe methods to treat thoracolumbar post-traumatic kyphosis.