MANAGEMENT OF RIGID POST-TRAUMATIC THORACOLUMBAR KYPHOSIS BY SIMULTANEOUS POSTERIO-ANTERIOR CIRCUMFERENTIAL RELEASING AND CORRECTION WITH PRESERVED POSTERIOR VERTEBRAL WALL_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WANG Qing , WANG Gaoju , ZHONG Dejun , XIU Peng , LI Sen , WANG Song.

Department of Spinal Surgery, Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P.R.China.;

Corresponding author：

Keywords：

Rigid post-traumatic thoracolumbar kyphosis; Circumferential release; Preserved posterior vertebral wall

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【Abstract】 Objective To evaluate the surgical management of rigid post-traumatic thoracolumbar kyphosis (RPTK) by simultaneous posterio-anterior circumferential releasing, correction and anterior corpectomy with preserved posterior vertebral wall. Methods Twenty patients with RPTK were treated between October 2004 and October 2010 by posterior releasing, anterior subtotal corpectomy with preserved posterior vertebral wall, correction, strut graft, and short segmental fixation. There were 14 males and 6 females with an average age of 43.2 years (range, 23-63 years). The time between injury and operation was 4 months to 23 years (mean, 1.4 years). The affected locations were T11 in 1 case, T12 in 8 cases, L1 in 10 cases, and L2 in 1 case. The Cobb angle and the intervertebral height of the fractured vertebra body were measured before and after operations. The degrees of low back pain were assessed by Japanese Orthopaedic Association (JOA) scores. Results No incision infection, nerve injury, or cerebral spinal fluid leakage occurred. Seventeen patients were followed up 1-5 years with an average of 2.8 years. The JOA score at last follow-up (26.2 ± 3.9) was significantly improved when compared with the pre-operative score (14.0 ± 5.7) (t=4.536, P=0.001). One patient had aggravation of kyphosis at 3 months postoperatively, who was in stabilized condition after prolonging immobilizated time. The Cobb angle was corrected from (43.2 ± 11.5)° preoperatively to (9.8 ± 5.7)° at last follow-up, showing significant difference (P lt; 0.01). There was significant difference in the intervertebral height of the fractured vertebra body between preoperation and last follow-up (P lt; 0.05). The intervertebral height of fractured vertebra was restored to 87.0% ± 11.2% of adjacent disc height. Conclusion Posterio-anterior circumferential releasing and anterior corpectomy with preserved posterior vertebral wall can achieve satifactory clinical results, not only in pain relieving, kyphosis correction, vertebral height restoration, and spinal stability restoration, but also in the risk reduce of bleeding and spinal cord disturbance.

Citation： WANG Qing,WANG Gaoju,ZHONG Dejun,XIU Peng,LI Sen,WANG Song.. MANAGEMENT OF RIGID POST-TRAUMATIC THORACOLUMBAR KYPHOSIS BY SIMULTANEOUS POSTERIO-ANTERIOR CIRCUMFERENTIAL RELEASING AND CORRECTION WITH PRESERVED POSTERIOR VERTEBRAL WALL. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(3): 261-265. doi: Copy

1.	Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7): e1-8.
2.	Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spine Disord Tech, 2006, 19(7): 487-494.
3.	Benli IT, Kaya A, Uruc V, et al. Minimum 5-year follow-up surgical results of post-traumatic thoracic and lumbar kyphosis treated with anterior instrumentation: comparison of anterior plate and dual rod systems. Spine (Phila Pa 1976), 2007, 32(9): 986-994.
4.	Wu SS, Hwa SY, Lin LC, et al. Management of rigid post-traumatic kyphosis. Spine (Phila Pa 1976), 1996, 21(19): 2260-2267.
5.	Been HD, Poolman RW, Ubags LH. Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J, 2004, 13(2): 101, 107.
6.	Colley DP, Dunsker SB. Traumatic narrowing of the dorsolumbar spinal canal demonstrated by computed tomography. Radiology, 1978, 129(1): 95-98.
7.	Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine J, 2001, 26(1): 61-66.
8.	Oner FC, van Gils AP, Dhert WJ, et al. MRI findings of thoracolumbar spine fractures: a categorization based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(28): 433-443.
9.	Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 3. Validity study and establishment of the measurement scale: Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association, Japan. J Orthop Sci, 2008, 13(3): 173-179.
10.	Krompinger WJ, Frederickson BE, Mino DE, et al. Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am, 1986, 17(1): 161-170.
11.	Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
12.	Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
13.	Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine (Phila Pa 1976), 2006, 31(18): 2137-2141.
14.	Mohanty SP, Venkatram N. Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise. Spinal Cord, 2002, 40(6): 295-299.
15.	Wilcox RK, Boerger TO, Hall RM, et al. Measurement of canal occlusion during the thoracolumbar burst fracture process. J Biomech, 2002, 35(3): 381-384.
16.	Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976), 2005, 30(6): 613-620.
17.	王清, 王松, 王高举, 等. 保留椎体后壁的前路技术治疗胸腰椎爆裂骨折. 中华创伤杂志, 2011, 27(5): 413-417.
18.	Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
19.	McCullen G, Vaccaro AR, Ganfin SR. Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technique. Orthop Clin North Am, 1998, 29(4): 813-828.
20.	Sasso RC, Best NM, Reilly TM, et al. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech, 2005, 18 Suppl: S7-14.
21.	Khoueir P, Oh BC, Wang MY. Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management. Neurosurgery, 2008, 63(3 Suppl): 117-124.

1. Schoenfeld AJ, Wood KB, Fisher CF, et al. Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech, 2010, 23(7): e1-8.
2. Lazennec JY, Neves N, Rousseau MA, et al. Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spine Disord Tech, 2006, 19(7): 487-494.
3. Benli IT, Kaya A, Uruc V, et al. Minimum 5-year follow-up surgical results of post-traumatic thoracic and lumbar kyphosis treated with anterior instrumentation: comparison of anterior plate and dual rod systems. Spine (Phila Pa 1976), 2007, 32(9): 986-994.
4. Wu SS, Hwa SY, Lin LC, et al. Management of rigid post-traumatic kyphosis. Spine (Phila Pa 1976), 1996, 21(19): 2260-2267.
5. Been HD, Poolman RW, Ubags LH. Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures. Eur Spine J, 2004, 13(2): 101, 107.
6. Colley DP, Dunsker SB. Traumatic narrowing of the dorsolumbar spinal canal demonstrated by computed tomography. Radiology, 1978, 129(1): 95-98.
7. Kuklo TR, Polly DW, Owens BD, et al. Measurement of thoracic and lumbar fracture kyphosis: evaluation of intraobserver, interobserver, and technique variability. Spine J, 2001, 26(1): 61-66.
8. Oner FC, van Gils AP, Dhert WJ, et al. MRI findings of thoracolumbar spine fractures: a categorization based on MRI examinations of 100 fractures. Skeletal Radiol, 1999, 28(28): 433-443.
9. Fukui M, Chiba K, Kawakami M, et al. Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 3. Validity study and establishment of the measurement scale: Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association, Japan. J Orthop Sci, 2008, 13(3): 173-179.
10. Krompinger WJ, Frederickson BE, Mino DE, et al. Conservative treatment of fractures of the thoracic and lumbar spine. Orthop Clin North Am, 1986, 17(1): 161-170.
11. Meves R, Avanzi O. Correlation between neurological deficit and spinal canal compromise in 198 patients with thoracolumbar and lumbar fractures. Spine (Phila Pa 1976), 2005, 30(7): 787-791.
12. Dai LY, Yao WF, Cui YM, et al. Thoracolumbar fractures in patients with multiple injuries: diagnosis and treatment-a review of 147 cases. J Trauma, 2004, 56(2): 348-355.
13. Meves R, Avanzi O. Correlation among canal compromise, neurologic deficit, and injury severity in thoracolumbar burst fractures. Spine (Phila Pa 1976), 2006, 31(18): 2137-2141.
14. Mohanty SP, Venkatram N. Does neurological recovery in thoracolumbar and lumbar burst fractures depend on the extent of canal compromise. Spinal Cord, 2002, 40(6): 295-299.
15. Wilcox RK, Boerger TO, Hall RM, et al. Measurement of canal occlusion during the thoracolumbar burst fracture process. J Biomech, 2002, 35(3): 381-384.
16. Kawahara N, Tomita K, Kobayashi T, et al. Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976), 2005, 30(6): 613-620.
17. 王清, 王松, 王高举, 等. 保留椎体后壁的前路技术治疗胸腰椎爆裂骨折. 中华创伤杂志, 2011, 27(5): 413-417.
18. Buchowski JM, Kuhns CA, Bridwell KH, et al. Surgical management of posttraumatic thoracolumbar kyphosis. Spine J, 2008, 8(4): 666-677.
19. McCullen G, Vaccaro AR, Ganfin SR. Thoracic and lumbar trauma: rationale for selecting the appropriate fusion technique. Orthop Clin North Am, 1998, 29(4): 813-828.
20. Sasso RC, Best NM, Reilly TM, et al. Anterior-only stabilization of three-column thoracolumbar injuries. J Spinal Disord Tech, 2005, 18 Suppl: S7-14.
21. Khoueir P, Oh BC, Wang MY. Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management. Neurosurgery, 2008, 63(3 Suppl): 117-124.

Chinese Journal of Reparative and Reconstructive Surgery

MANAGEMENT OF RIGID POST-TRAUMATIC THORACOLUMBAR KYPHOSIS BY SIMULTANEOUS POSTERIO-ANTERIOR CIRCUMFERENTIAL RELEASING AND CORRECTION WITH PRESERVED POSTERIOR VERTEBRAL WALL

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