The surgical treatment method for an adult posttraumatic thoracolumbar kyphosis patient with osteogenesis imperfecta.

Abstract

Osteogenesis imperfecta (OI) is an inheritable bone disorder characterized by osseous fragility and ligamentous laxity. It is sometimes difficult to obtain bone union in patients with OI. The purpose of this report is to present a rare case of posttraumatic kyphosis due to a L1 burst fracture in a patient with OI, and to discuss how to treat it to achieve an adequate correction and circumferential fusion. The patient was a 29-year-old man with OI (Sillence type-IA) who had sustained an L1 fracture when he dived head first into a river. After 3 months of conservative therapy with a body cast, he showed disability at work because of his persistent low back pain and fatigue in his whole back. He showed no neurological disorder. Diagnostic imaging revealed localized kyphotic deformity at L1. Therefore, lumbar lordosis and thoracic kyphosis worsened. Anterior release and fusion, and posterior fusion were conducted. Three months after surgical treatment, circumferential fusion was obtained. His low back pain and fatigue in the whole back disappeared, and he could resume work without any difficulty. From the bone union standpoint, the surgical strategy for spinal correction in OI patients is still controversial because of the intractableness of bone union and fragility of the bone itself. The authors achieved circumferential union using anterior fusion and posterior fusion, in which wide bone bed is available owing to spared posterior elements of the spinal column.