Treatment of late posttraumatic spinal kyphosis with no osteotomy or only posterior column osteotomy based on prone imaging parameters

Abstract

Background The current surgical options for late posttraumatic spinal kyphosis are primarily based on standing x-rays. The degree of deformity is reduced in the prone position. This self-correction of the deformity could be achieved without osteotomy or instruments, making large osteotomies no longer necessary. Osteotomy based on prone imaging data for the treatment of late posttraumatic kyphosis has not been reported. We, therefore, aimed to evaluate the clinical efficacy of simple posterior column osteotomy or non-osteotomy based on prone x-rays. Methods From April 2017 to November 2020, we collected preoperative standing, prone, postoperative, and final follow-up imaging data of 18 patients admitted to our hospital for late posttraumatic kyphosis using simple posterior column osteotomy or non-osteotomy. Preoperative prone data of thoracic kyphosis angle (TK), local kyphosis Cobb angle (LKCA), and lumbar lordosis angle (LL), was obtained. Preoperative, immediate postoperative, and final follow-up TK, LKCA, LL, sagittal vertebral axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis angle (PI-LL) data was also obtained on standing x-ray imaging. The operative time, bleeding, and operative complication rate was collected and analyzed. We compared the preoperative, two month postoperative, and final follow-up Oswestry disability index (ODI) and visual analog score (VAS) scores to evaluate the surgical results. Result LKCA and TK significantly reduced from the standing to prone position before surgery. The LKCA, TK, and SVA of immediate postoperative and last follow-up data were statistically different compared with those before surgery; the differences in LL, PT, and PI-LL in the postoperative period and at the last follow-up were not statistically significant compared with those before surgery. All patients were operated upon successfully, with an operative time of 152.7 ± 34.2 min, a bleeding volume of 408.3 ± 135.3 ml, no complications of infection or nerve injury, and a decrease in ODI scores and VAS scores at two months and at the last follow-up (P < 0.05) after surgery. Conclusion Based on prone imaging, simple posterior column osteotomy or non-osteotomy surgery for traumatic kyphosis with good flexibility and no neurological symptoms is safe, with potential reduction in operative time, complications, and bleeding.