Post-traumatic Spinal Deformity

Abstract

There are approximately 50,000 fractures to the bony spinal column each year in the United States. The vast majority of unstable spinal injuries are recognized early and managed appropriately. Rarely, the initial treatment may have been inadequate, or in less obvious injuries, less aggressive immobilization techniques may have been chosen. This along with continued exposure to physiologic stresses may lead to a gradual post-traumatic deformity that may further impede the functional as well as emotional status of these often already compromised patients. The management of post-traumatic deformity can be extremely challenging. A post-traumatic kyphotic deformity may occur in the cervical, thoracic, thoracolumbar, or lumbar spine, and once appropriate imaging studies are obtained, careful surgical considerations must be undertaken. Surgical intervention is considered if the kyphotic deformity is progressive over time or there is new onset or progression of a neurologic deficit. Surgical procedures include either a posterior or anterior only approach or any variation of a combined anterior or posterior procedure. In most cases a posterior only fusion is often insufficient for optimal correction and stabilization. Although the majority of patients developing a post-traumatic deformity usually occur after spinal column trauma initially treated nonoperatively, several miscellaneous causes of post-traumatic deformity may occur after surgery. These include nonunion, implant failure, Charcot spine, and technical error. The overall outcome after the surgical management of post-traumatic deformity has been satisfactory with better outcomes in the patients treated earlier as opposed to later. Operative complications include the increased risk of neurologic injury because of the draping of the neural elements over the anterior vertebral elements, any pre-existing spinal cord injury, and possible scarring with cord tethering. Trauma to the spinal cord and column is a devastating injury that may be fraught with many complications including post-traumatic deformity. Certainly, the best treatment is prevention with close follow-up and early intervention when needed. Once present, the treatment of post-traumatic deformity follows basic biomechanical principles consisting of re-establishing the integrity of the compromised spinal columns so that spinal stability can be restored.

Adjacent Level Degeneration and Post-Traumatic Deformity After Thoracolumbar Fractures

“…23 This study showed that the presence of post-traumatic deformity occurs linearly and progressively in patients treated surgically for thoracolumbar fractures with 2-year follow-up. Regardless of whether the synthesis material was removed or not, the study showed that there was statistically significant progression of the Cobb angle.…”

Management of degenerative changes and stenosis of the lumbar spinal canal secondary to cervical spinal cord injury

“…One of the first reports of tethering as a problem in adults after SCI has been given by Ragnarsson et al 21 It has gained more attention lately and the literature indicates that it is accepted as a source of problems by a mechanism that is caused by adhesions at the level of the injury. [22][23][24] However, there is still no uniform definition of tethering or of the diagnostic approach. 25,26 To include cervical tethering in our list of differential diagnosis, we would have expected changes to the neurologic status of the upper extremities and we would not be able to explain why the straight leg raising test so constantly reproduced the symptoms.…”

Modified Pedicle Subtraction Osteotomy for Posttraumatic Kyphosis: Long Term Follow-Up

“…10,18 Patients with focal kyphotic deformity equal to or greater than 30° have an increased risk of chronic pain or neurologic deficit. 19 Pain intractable to conservative treatment, progressive deformity, or progressive neurological deficit are the main indications for surgical intervention.…”

“…19 Pain intractable to conservative treatment, progressive deformity, or progressive neurological deficit are the main indications for surgical intervention. 5,7,18 However, the treatment of such patients can be quite challenging.…”