Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation

Abstract

Rationale:Thoracic-lumbar vertebral fracture is very common in clinic, and late post-traumatic kyphosis is the main cause closely related to the patients’ life quality, which has evocated extensive concern for the surgical treatment of the disease. This study aimed to analyze the clinical outcomes and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation.Patient concerns:All patients presented back pain with kyphotic apex vertebrae between T12 and L3. According to Frankel classification grading system, among them, 3 patients were classified as grade D, with the ability to live independently.Diagnoses:A systematic review of 12 case series of post-traumatic kyphosis after failed thoracolumbar fracture operation was involved.Interventions:Wedge osteotomy was performed as indicated—posterior closing osteotomy correction in 5 patients and anterior open-posterior close correction in 7 patients.Postoperatively, thoracolumbar x-rays were obtained to evaluate the correction of kyphotic deformity, visual analog scales (VAS) and Frankel grading system were used for access the clinical outcomes.Outcomes:All the patients were followed up, with the average period of 38.5 months (range 24–56 months). The Kyphotic Cobb angle was improved from preoperative (28.65 ± 11.41) to postoperative (1.14 ± 2.79), with the correction rate of 96.02%. There was 1 case of intraoperative dural tear, without complications such as death, neurological injury, and wound infection. According to Frankel grading system, no patient suffered deteriorated neurological symptoms after surgery, and 2 patients (2/3) experienced significant relief after surgery. The main VAS score of back pain was improved from preoperative (4.41 ± 1.08) to postoperative (1.5 ± 0.91) at final follow-up, with an improvement rate of 65.89%.Lessons:Surgical treatment of late post-traumatic kyphosis after failed thoracolumbar fracture operation can obtain good radiologic and clinical outcomes by kyphosis correction, decompression, and posterior stability.

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

“…In addition, the tension of spinal cord is often increased following corrective procedure, that can be decreased effectively by repeated spinal shortening and compression. 10,17 In our study, complications occurred in 5 patients in the form of dural tears in two patients that discovered and managed intraoperatively. Four out of the five patients who had preoperative neurological complaints had postoperative complete recovery, while the fifth one had postoperative paraparesis grade D according to American Spinal Injury Association (ASIA) and had complete recovery after 8 months of physiotherapy.…”

“…9,8 Late PTK is considered a major complication of the poorly managed thoracolumbar fracture which can lead to progressive deformity, neurological deficit and intolerable back pain. This refractory back pain is usually due to fracture non-union, compensatory hyperlordosis and from the muscle fatigue due to the sagittal imbalance developed in severe patients 10 . It has been estimated that the cutoff of the surgical management is the presence of more than 20 • focal kyphosis which is important with other determinant in the patients.…”

“…SPO was first performed for the treatment of kyphotic deformity by resecting of the posterior elements of the vertebra in 1945. 10 One single SPO is expected to correct about 10-15 • , which is difficult to achieve satisfactory outcomes for the sharp kyphosis in thoracic or lumbar spine. 4,10 Pedicle subtraction osteotomy (PSO) is mostly recommended as the surgical procedure for the treatment of sagittal imbalance from a kyphotic deformity.…”

“…10 One single SPO is expected to correct about 10-15 • , which is difficult to achieve satisfactory outcomes for the sharp kyphosis in thoracic or lumbar spine. 4,10 Pedicle subtraction osteotomy (PSO) is mostly recommended as the surgical procedure for the treatment of sagittal imbalance from a kyphotic deformity. 11 PSO correction is limited to 30-40 • which can be insufficient in severe rigid deformities and the potential of neurological affection increases if more correction is performed from spinal cord shortening and distortion.…”

Application of transforaminal‑lumbar interbody fusion technology combined with lesion clearance and chemotherapy via catheter for the treatment of spinal tuberculosis

“…The cohort comprised 17 men and 9 women, and their mean age was 45 years (range, 19-69 years). Neurological assessment was performed using Frankel grading (12); three patients were rated as Frankel grade B, six were of grade C and seven were of grade D. A total of 10 patients without any neurological deficits were assigned a Frankel grade E. For each of the patients, pre-operative anteroposterior and standing radiographs of the spine were recorded, and computed tomography (CT) scans, magnetic resonance imaging and hematological investigations, including complete blood cell count, ESR and CRP, were performed. Surgical procedure.…”