Surgical Treatment in Delayed Posttraumatic Thoracolumbar Kyphosis

Suk, Se Il; Lee, Choon Ki; Yoon, Kang Sup; Lee, Ji Ho; Kim, Won Joong; Moon, Sang Ho

Abstract

STUDY DESIGN: This is a retrospective study analyzing the clinical results of various surgical methods for the treatment of delayed posttraumatic kyphosis.
OBJECTIVES
The purposes of this study are to define the risk factors of delayed postraumatic kyphosis and to establish a rational therapeutic guideline for the treatment of established kyphosis.
METHODS
Sixteen cases of surgically treated delayed posttraumatic kyphosis were analyzed. Their initial injuries were burst type in 10, flexion-distraction in 5 and uncertain in l. Initial treatments were conservative in 10 and surgical in 6. Treatments for established kyphosis were posterior fusion in 2, anterior fusion in 5, combined anterior-posterior fusion in 9. Anterior decompression was carried out in 5 treated with anterior fusion and in 4 treated with combined anterior-posterior fusion.
RESULTS
Mean follow-up was 2.7 years. The mean preoperative kyphosis of 28.6ã€‚ was reduced to 18.5ã€‚ (35.3% correction) with most pronounced correction in the group with combined anterior and posterior stabilization(44.8% correction). Early loss of correction averaged 2.7ã€‚ (18.5%) with least loss in the combined anterior-posterior group. Neurological improvement was related to the duration of the symptoms(P < 0.05). Back pain was improved in all patients.
CONCLUSIONS
Thoracolumbar fractures with initial three column injuries or those rendered unstable by laminectomy are highly susceptible to development of delayed posttraumatic kyphosis; Combined anterior and posterior fusion offered the most satisfactory result in correction and stabilization of the deformity; Neurologic improvement was more pronounced with shorter duration of the symptoms.