Transpedicular Wedge Opening (TWO) Osteotomy for Post-Traumatic Kyphosis (PTK): Own Technique and Preliminary Results

Abstract

IntroductionManagement for symptomatic post-traumatic kyphosis always has presented a challenge to orthopedic surgeons. The management for post-traumatic kyphosis remains controversial: Anterior, posterior, or combined anterior and posterior procedures have been advocated by different authors and show various degrees of success. All of these techniques end in abnormal morphology of the affected vertebra, so in this technique we try to restore the normal sagittal balance by restoring the normal morphology of the affected vertebra (natural kyphoplasty). Material and MethodsBetween May 2010 and Jun 2014 30 patients with symptomatic kyphotic deformity were treated with TWO osteotomy. Twenty-two are males and eight are females. The mean age of patients was 37 years (range 18- 62 years). All patients had history of old trauma with time lag till surgerical interferance was 10 months in average (3m- 12y.). They underwent TWO osteotomy of the wedged VB bisegmental TPSF through posterior-alone approach The clinical evaluation throughout the study entailed visual analogue scale (VAS) and Oswestry disability index. The local kyphotic angel (LKA), sagittal balance (SB) and sagittal index (SI) were measured preoperatively, postoperatively and during the follow up visits. Radiographic bony healing of the v-shaped VB defect which left after the TWO osteotomy is confirmed by MSCT. ResultsThe mean follow up period was 26.5 months (range12- 48 m.). TWO osteotomy was done for wedged VB between D10 and L2. The mean operative time was 110 minutes (range 70- 180 minute.) and the mean intraoperative blood loss was 625 cc (range 400- 1700 cc). The mean preoperative LKA was 28.7° (range 20- 56°) that had been improved to -2° (range 8°- (−10°)) postoperatively. Lordotic correction of 30.8° (range 22–48°) was achieved with minimum loss of correction (range 0- 8°) through the period of follow up. The mean period required for radiographic bony healing of the osteotomy was 7 months (range 3–15m.). The VAS &ODI had been improved significantly (p.005) in comparison to preoperative values. Excellent clinical and radiographic outcomes were achieved in 92% of cases with no major complications. ConclusionSpontaneous bony healing after TWO of wedged VB occurs without doubt. This study evoked the concept of “Natural Kyphoplasty” for treatment of certain cases of PTK. Although it is a newly described technique, it was proved to be safe and effective method for treatment of symptomatic thoracolumbar PTK.