Post-traumatic Kyphosis Research Articles

Surgical treatment of posttraumatic kyphosis of the lumbar spine: compensatory changes and dynamics of sagittal balance

Surgical treatment of posttraumatic kyphosis of the lumbar spine: compensatory changes and dynamics of sagittal balance

Radiological and Clinical Outcomes after Surgical Correction of Post-traumatic Kyphosis by multiple Ponte osteotomies

Radiological and Clinical Outcomes after Surgical Correction of Post-traumatic Kyphosis by multiple Ponte osteotomies

Biportal Endoscopic Lumbar Ponte Osteotomy for Kyphosis: A Technical Note

Biportal endoscopic lumbar Ponte osteotomy (BELPO) is an innovative technique for correcting kyphotic deformities. Unlike the original technique, which maintains an intact anterior column, BELPO involves the endoscopic release of the anterior elements in addition to the endoscopic resection of the posterior elements in interbody fusion. BELPO is performed using unilateral biportal endoscopy with the patient in a prone position. First, a small incision is made in the midline over the interspinous gap. Through this gap, a generous portion of the spinous processes and interspinous ligament is removed. Using this incision as both the viewing and working portal, complete facetectomy and partial laminectomy are performed. Posterior compression is then applied to achieve the desired lordosis. Pedicle screws are fixed with cement augmentation. A 71-year-old female patient presented with low back pain and positive sagittal imbalance. She had a rigid posttraumatic kyphosis at L2–3 due to an old compression fracture at L3. After BELPO, the kyphosis at L2–3 improved from 21º to 2º. BELPO is a promising novel method of minimally invasive deformity correction, offering particular advantages for frail, osteoporotic patients.

Posterior vertebral column resection: Exploring practical uses in clinical settings.

The purpose of this study was to present our experience in patients who had been treated with posterior vertebral column resection (PVCR) for various spinal deformities. Thirty-seven patients who performed PVCR between 2015 and 2018 were evaluated retrospectively. The mean follow-up period was 24 months (range: 12-50 months). The demographic data of the patients, mean blood loss, amount of blood replacement, duration of operation, intensive care and hospitalization period, PVCR level, instrumentation level, amount of preoperative curvature, amount of postoperative curvature improvement, preoperative and postoperative neurological status, and complications were examined. Angular measurements were performed on X-ray. The mean age of the patients was 37.5 years (range: 3-80 years). PVCR was applied to patients due to different pathologies (congenital, tumor metastasis, posttraumatic kyphosis, revision scoliosis, and infection). The mean operation time was 445.5 min (260-720) with an average blood loss of 1903 ml (400-7000 ml). It was observed that the average local kyphosis angle decreased from 67.65° to 7.42° in 26 patients who were operated for advanced deformity (P < 0.001). When these values were compared in all 34 patients, the preoperative angle value decreased from 55.1° to 3.5° (P < 0.001) and decreased from 70° to 0° in 13 congenital kyphosis patients. PVCR is an effective method for correcting severe spinal deformities and can be used to correct curvature in different patient groups. Level 3.

Surgical management of posttraumatic thoracolumbar Kyphosis: A review.

Kyphosis is a condition in which there is a curvature of the spine that causes a bowing of the back, which in turn leads to slouching posture or hunchback. There are several types of Kyphosis, including posttraumatic Kyphosis, which usually occurs in the thoracic region. There are several techniques used for the surgical management of posttraumatic thoracolumbar Kyphosis. We aimed to discuss the surgical treatment of posttraumatic thoracolumbar Kyphosis. We searched for articles included in this review through scientific websites using different keywords. The articles were chosen based on inclusion criteria. The articles included in this review were published between 2006 and 2018. The review was written under titles in the discussion part. The outcome of the surgical management of posttraumatic thoracolumbar Kyphosis depends on the accurate selection of the proper surgical approach.

Defining threshold for sagittal correction in lumbar fractures.

Surgical indications for thoraco-lumbar fractures are driven both by neurological status, fractures instability and kyphotic deformity. Regarding kyphotic deformity, an angulation superior to 20° is considered by many surgeons as a surgical indication to reduce the disability induced by post-traumatic kyphosis. However, there is a lack of data reporting the ideal or theoretical lordosis that one must have in a particular lumbar segment on CT-scan. The main goal of this study was to determine the mean value for segmental lumbar lordosis according to pelvic incidence (PI) on a cohort of normal subjects. The consecutive CT-scan of 171 normal adult subjects were retrospectively analyzed. The PI and the segmental lordosis (L4S1, L3L5, L2L4, L3L1, L2T12 and T11-L1) were measured on all CT-scan. The mean values were calculated for the global cohort and a sub-group analysis according to IP ranges (< 45°, 45 < IP < 60° and > 60°) was performed. The mean angular values for the whole cohort were IP: 54, 9°; L4S1: - 38, 1°; L3L5: - 30, 6°; L2L4: - 14, 1°; L1L3: - 4, 9°; T12L2: + 1, 9° and T11L1: + 5, 4°. The segmental values vary significatively with PI ranges, as for L3L5: - 26, 8° (PI < 45°); - 30° (45 < PI < 60°) and - 35, 1° (PI > 60°). These results provide a referential of theoretical values of segmental lordosis according to PI. This abacus may help spinal surgeon in their decision-making process regarding lumbar fractures, to determine the amount of sagittal correction needed, according to the PI range, to be adapted to the sagittal morphology of the patient. III.

Experience in Managing Posttraumatic Lumbar Kyphosis Patients with Multi-level Ponte Osteotomies and Posterior Spinal Fusion

Posttraumatic kyphosis (PTK) is a spinal deformity resulting from severe trauma, posing significant challenges for surgical correction. PTK can lead to chronic pain and disability, necessitating careful evaluation and individualized treatment strategies. We present the case of a 50-year-old male with a decade-long history of PTK following a traumatic fall from a truck. Despite initial mobility, his condition worsened, affecting his posture and causing pain. Radiographic assessments revealed marked lumbar lordosis (LL) loss, positive sagittal vertebral axis, and pelvic parameters mismatch. Surgical planning involved multilevel Ponte osteotomy from L1 to L4 and posterior spinal fusion from Th10 to S1 to restore sagittal balance. Treating PTK is complex and technically demanding, with no universal approach due to the diversity of cases. Detailed diagnostics, including spinal alignment analysis and neurologic assessments, guide surgical decisions. Our patient’s successful treatment employed grade 1/2 Ponte osteotomies for lumbar correction, achieving improved sagittal balance and LL. However, an increase in pelvic incidence (PI) and persistent PI-LL mismatch was noted postsurgery, suggesting potential effects on the sacroiliac joint. Severe trauma can lead to PTK, necessitating meticulous evaluation and individualized surgical strategies. The primary goal is to alleviate neurological deficits and restore sagittal balance, with surgical choices tailored to each patient’s unique circumstances. Surgical correction may influence pelvic parameters, emphasizing the importance of comprehensive postoperative assessment and follow-up care.

Finite Element Analysis of Bilateral Double Rod Constructs in Thoracolumbar Fractures.

To evaluate bilateral double rod contructs in thoracolumbar fractures in a Finite Element model MATERIAL and METHODS: A computed tomography of a 35-year old male have been chosen to create a vertebra model and 1/3 of the T12 was removed to create the burst fracture model. In model A, transpedicular polyaxial screws were inserted two levels above and two levels below the burst fracture. On each side the screws were connected with a single rod. In model B, the screws were connected with two rods on each side attached to two lateral connectors. A uniform 150 N axial load and 10 N/m torque was applied on the superior T10. ROM and von Mises stress nephrograms revealed that the bilateral double-rod construct is being the most rigid and that the force on the pedicle screws were significantly lower compared to model A. We believe that bilateral double-rod constructs for the stabilization of thoracolumbar fractures have a decreased load on pedicle screws and rods compared to the classic bilateral single rod stabilization system and can lower the risk of implant failure and the risk for secondary complications and revision surgery.

Treatment of Post-Traumatic Kyphosis of the Spine with Pedicle Subtraction Osteotomy: Case Report

Treatment of Post-Traumatic Kyphosis of the Spine with Pedicle Subtraction Osteotomy: Case Report

Factors Associated with Intradiscal Vacuum Phenomenon after Traumatic Thoracolumbar Fracture.

Introduction Posttraumatic kyphosis of the thoracolumbar spine is a possible cause of deterioration of activities of daily living. Thus, postoperative kyphosis is an important issue in treating traumatic thoracolumbar fractures. The intradiscal vacuum phenomenon (IVP) after a traumatic thoracolumbar fracture is considered an important predictor of severe kyphosis after implant removal. However, the associated factors are not yet clear. Methods The study included data from 94 intervertebral discs on the cephalocaudal side of 47 fractured vertebrae of 45 patients for traumatic thoracolumbar fracture due to high-energy trauma. We assessed the demographics of patients (age, sex, cause of injury, location of injured vertebra, fracture type, cephalocaudal side), imaging finding (kyphosis angle of fractured vertebra at the injury, endplate fracture on computed tomography [CT], intervertebral injury on magnetic resonance image [MRI]), and IVP on CT conducted more than 6 months after surgery. We divided the intervertebral discs into an IVP group and a non-IVP group. To identify factors associated with an IVP, univariate analysis and multivariate logistic regression analysis were conducted. Results IVP was observed in 27 (29%) of 94 intervertebral discs on CTs conducted at an average of 14.0 months postoperatively. In univariate analysis, the IVP group ( n = 27) had a significantly more cephalic side of the injured vertebra, endplate fracture on CT, and disc injury on MRI compared with the non-IVP group ( n = 67). A multivariate logistic regression analysis was conducted to identify factors associated with IVP. The cephalic side (odds ratio [OR] = 4.183, 95% confidence interval [CI] = 1.269-13.785) and endplate fracture on CT (OR = 9.564, 95% CI = 1.940-47.143) were identified as independent factors associated with IVP. Conclusions IVP was observed in 27 (29%) of 94 intervertebral discs. The cephalic side and endplate fracture on CT were identified as independent factors associated with IVP.

Radiological and Clinical Outcomes after Surgical Correction of Thoracolumbar Posttraumatic Kyphosis by Vertebral Column Resection

Radiological and Clinical Outcomes after Surgical Correction of Thoracolumbar Posttraumatic Kyphosis by Vertebral Column Resection

Compensation mechanisms for post-traumatic thoracolumbar kyphosis

Objective. To identify the mechanism of deformity compensation in patients with post-traumatic kyphosis of the thoracolumbar junction, based on the analysis of X-ray results of surgical treatment.Material and Methods. The study included data obtained from medical records of 69 patients (47 women, 22 men) operated on for painful post-traumatic kyphosis at the levels of T12, L1 and L2 vertebra. Patients underwent staged surgical interventions in a single surgical session. Demographic data and X-ray results of surgical treatment were evaluated.Results. As a result of surgical interventions, post-traumatic kyphosis (LK) was corrected to an average of 1.9°. After correction of kyphosis, statistically significant changes in the parameters of sagittal spinal curvatures were revealed: an increase in thoracic kyphosis (TK), a decrease in lumbar lordosis (LL), including due to lower lumbar lordosis (LowLL). At the same time, the parameters of the spinopelvic balance (PT, SS) did not change. Statistically significant correlations (p &lt; 0.001) were detected between the magnitude of local kyphosis correction (LK preOP-LKpostOP), which amounted to 33.63° ± 8.77°, and parameters of lumbar lordosis ΔLL, thoracic kyphosis ΔTK and ΔPI-LL. Parameters of global sagittal balance and pelvic balance did not show correlations with the magnitude of kyphosis correction. The X-ray study of patients in Group I (without signs of initial sagittal imbalance) and Group II (with signs of sagittal imbalance) revealed a statistically significant difference in global balance (GT) and spinopelvic balance (PT, SS, LowLL), both before and after correction intervention in the thoracolumbar junction area, despite comparable indicators of sagittal spinal curvatures and the magnitude of post-traumatic kyphosis,.Conclusion. The main compensation mechanism includes changes in the spinal departments adjacent to kyphosis: a decrease in thoracic kyphosis and an increase in lumbar lordosis, rather than changes in the global or spinopelvic balance.

MINIMALLY INVASIVE SPINE SURGERY FOR POST-TRAUMATIC KYPHOSIS: A SYSTEMIC LITERATURE REVIEW AND RETROSPECTIVE CASE ANALYSIS

Study Design: Retrospective case analysis and systematic literature review. Objective: To comprehensively review minimally invasive surgery (MIS) for post-traumatic kyphosis. Methods: A systematic PubMed search was conducted for MIS and kyphotic deformities were published between 2012 and 2022. Sixteen patients between 2017 and 2021 met the criteria. Demographic data, surgical characteristics, and full-length radiographic parameters were collected pre- and post-operatively, and at final follow-up. Results: Twenty-three articles were included. The mean age was 67 years, and the mean follow-up was 17 months. The mean operative time was 331 min and blood loss was 252 ml. Pre-operative radiographic outcomes were as follows: Lumbar lordosis (LL), 16.84± 26.40[Formula: see text]; pelvic incidence (PI), 48.95± 14.34[Formula: see text]; PI-LL mismatch, 32.11± 31.92[Formula: see text]; pelvic tilt (PT), 32.74± 10.41[Formula: see text]; and sagittal vertical axis (SVA), 95.33± 59.62 mm. At the final follow-up, LL was 19.98± 16.16[Formula: see text] ([Formula: see text] = 0.51229), PI was 50.82± 10.19[Formula: see text] ([Formula: see text] = 0.61438), PI-LL mismatch was 30.84± 17.18[Formula: see text] ([Formula: see text] = 0.74696), PT was 27.14± 10.28[Formula: see text] ([Formula: see text] = 0.00386), and SVA was 49.73± 25.51 mm ( [Formula: see text] = 0.00465). The mean ODI and VAS scores for back pain at baseline and at 96 months follow-up were 33.2–19.7 and 8.4–2.5, respectively. Conclusion: Age-adjusted MIS provides correction of sagittal alignment for posttraumatic kyphosis that satisfies patient demand.

SHORT- TO MIDTERM RADIOGRAPHIC AND CLINICAL OUTCOMES OF ANTERIOR OPENING OSTEOTOMY WITH LAMINA SPARING IN POST-TRAUMATIC KYPHOSIS: A CASE SERIES

Purpose: Most spinal osteotomy procedures applied for spinal deformity and concomitant malalignment cases are associated with varied complications. This study evaluates the short- to midterm clinical and radiographic efficacy of the transpedicular anterior opening osteotomy technique. Methods: We retrospectively enrolled six patients who underwent transpedicular anterior opening osteotomy due to symptomatic rigid kyphotic deformity from May 2005 to 2016. During surgery, we created a new fracture line at the collapsed anterior vertebral body through bilateral pedicles, filled spaces with compacted bone grafts while preserving posterior elements, including lamina, and secured structure using posterior instrumentation. The kyphotic Cobb angle, Visual Analog Scale (VAS), and Oswestry Disability Index (ODI) before and after surgery were measured and analyzed. Results: The mean preoperative kyphotic Cobb angle was 31.41 ± 4.77[Formula: see text] while the postoperative value was 15.75 ± 1.66[Formula: see text]. The mean correction angle was 15.55 ± 6.66[Formula: see text]. The mean follow-up duration was 50.17 ± 44.16 months. During the final follow-up, the mean kyphotic angle was not statistically different from the postoperative values. All patients with documented VAS Back and ODI had improved values postoperatively. Conclusions: Transpedicular anterior opening osteotomy with posterior element preservation improves clinical outcomes and is safe and effective in correcting regional, fixed kyphotic deformities.

ROLES OF SPINAL OSTEOTOMIES ON CORRECTION OF POST-TRAUMATIC THORACOLUMBAR KYPHOSIS

Thoracolumbar (T–L) fracture may create focal kyphosis accompanied by altered sagittal alignment, instability and potential neurological deficits. Surgical intervention for post-traumatic T–L kyphosis aims to restore sagittal balance, release compromised neural structures, and to improve the symptoms related to the malalignment. It is best indicated when there is a progression of kyphotic deformity, and/or when there are new or progressive neurological deficits. A kyphotic deformity [Formula: see text] is susceptible to persistent chronic pain in the kyphotic region and surgical correction is often required. Those with posterior ligamentous complex injury may also warrant surgical correction as there is a higher risk of kyphosis progression. A number of surgical procedures could be employed to correct post-traumatic T–L kyphosis. Spinal osteotomies are often needed to improve global, sagittal or coronal balance including in the late and fixed post-traumatic kyphosis. Based on different extent of focal kyphosis and global malalignment, surgical options may include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), disc-bone osteotomy (DBO), vertebral column resection (VCR) or closing opening wedge osteotomy (COWO). The type of spinal osteotomy utilized to correct post-traumatic T–L kyphosis should be chosen based on the severity of the deformity, the alignment of the spine, and the surrounding structures. In the meantime, potential complications should be reduced with novel techniques and proper constructs. When all associated factors are considered, surgical correction composing a suitable spinal osteotomy can be a beneficial and rewarding procedure for patients with post-traumatic T–L kyphosis.

Prevention of post-traumatic kyphosis in spine trauma using pedicle instrumentation with and without fracture-level screws

Prevention of post-traumatic kyphosis in spine trauma using pedicle instrumentation with and without fracture-level screws

Surgical management of thoracolumbar junction fractures: An evidence-based algorithm

BackgroundThe management of thoracolumbar junction (TLJ) fractures, involving the restoring anatomical stability and biomechanics properties, still remains a challenge for neurosurgeons.Despite the high frequency of these injuries, specific treatment guidelines, set on biomechanical properties, have not yet been assumed. The present study is meant to propose an evidence-based treatment algorithm. The primary aim for the protocol validation was the assessment of postoperative neurological recovery. The secondary objectives concerned the evaluation of residual deformity and rate of hardware failure. Technical nuances of surgical approaches and drawbacks were further discussed. MethodsClinical and biomechanical data of patients harboring a single TLJ fracture, surgically managed between 2015 and 2020, were collected. Patients' cohorts were ranked into 4 groups according to Magerl's Type, McCormack Score, Vaccaro PLC point, Canal encroachment, and Farcy Sagittal Index. The outcome measures were the early/late Benzel-Larson Grade and postoperative kyphosis degree to estimate neurological status and residual deformity, respectively. Results32 patients were retrieved, 7, 9, 8, and 8 included within group 1, 2, 3, and 4, respectively. Overall neurological outcomes significantly improved for all patients at every follow-up stage (p ​< ​0.0001). Surgeries gained a complete restoration of post-traumatic kyphosis in the entire cohort (p ​< ​0.0001), except for group 4 which experienced a later worsening of residual deformity. ConclusionsThe choice of the most appropriate surgical approach for TLJ fractures is dictated by morphological and biomechanical characteristics of fracture and the grade of neurological involvement. The proposed surgical management protocol was reliable and effective, although further validations are needed.

Open vs Percutaneous Pedicle Instrumentation for Kyphosis Correction in Traumatic Thoracic and Thoracolumbar Spine Injuries.

Percutaneous pedicle instrumentation (PPI) has been used for the treatment of thoracic and thoracolumbar (TL) trauma. However, the ability of PPI to correct significant post-traumatic kyphosis requires further investigation. The objective of this study is to compare the amount of kyphosis correction achieved by PPI vs the traditional open posterior approach in patients presenting with significant kyphotic deformity following traumatic thoracic and TL spine injuries. Following Institutional Review Board approval, patients who underwent surgery for thoracic (T1-T9) or TL (T10-L2) fractures with at least 15° of focal kyphosis in a 5-year period were included in this study. Patients were separated into 2 cohorts based on surgical technique: traditional open posterior approach and minimally invasive PPI. Kyphosis correction was measured using Cobb angle 1 vertebrae above and 1 below the level of injury on sagittal preoperative computed tomography image, immediate and follow-up postoperative upright lateral radiographs. Initial degree of correction and loss of correction at the final follow-up were compared. Of 91 patients included, 65 (71%) underwent open surgery and 26 (29%) underwent PPI. Open patients had 11° (95% CI, 9°-13°) of immediate correction compared with 11° (95% CI, 6°-15°) for PPI (P = 0.81). Follow-up data were available for 70 patients with a median of 105.5 days. Both groups had 1° (95% CI, 0°-2°) of loss of correction at follow-up (P = 0.82). Regardless of surgical technique, obesity (>30 kg/m2) and AO type-A compression fractures had significantly less correction. For each unit of body mass index, there was a 0.75° decrease in correction achieved (P < 0.0001). Other factors did not influence the degree of correction. PPI techniques provide equivalent postoperative angular correction and maintenance of correction compared with open surgery in thoracic and TL trauma patients. This study provides evidence for spine surgeons to utilize either technique for treating significant traumatic kyphotic deformity. Therapeutic 3.

The Outcome of Pedicle Subtraction Osteotomy (PSO) For the Correction of Post-Traumatic and Post-Tubercular Kyphotic Deformity

Introduction: Pedicle subtraction osteotomy (PSO) is one of the well-established and well-known techniques for kyphosis correction. Objective: Objective of our study is to analyze the clinical and radiological outcomes of PSO in terms of VAS to access the pain relief, ODI to assess the functional outcome, and the ASIA impairment scale for preoperative and postoperative assessment of neurology. The per-operative and postoperative complications related to surgery, access radiological correction of deformity in terms of kyphosis angle, and postoperative fusion status. Method: Ten patients with dorso-lumbar kyphosis (5 post-tubercular and 5 post-traumatic) were followed up for an average of 2 years after PSO. They were assessed prospectively for clinico-radiological and functional outcomes. The neurological deficit, cosmetic deformity &amp; back pain were the major complaints among the study population. Result: For the post-tubercular kyphosis group, the mean pre-operative kyphosis angle was 67.5°±10.4° and 14.9°±6.1° postoperatively, with significant improvement (p&lt;0.001) at a mean follow-up of 24 months. The mean ODI improved from 44.1±12.4 pre-operatively to 21.1±7.1 at the latest follow-up. Pre-operative VAS was 8.9±2.5, with a significant improvement of 1.5±1 in the final follow-up. For the post-traumatic kyphosis group, the mean pre-operative kyphosis angle was 33.7°±4.5° and 3.8°±3.4° postoperatively, with a significant improvement (p&lt;0.001). Here the mean ODI improved from 37±2.5 pre-operatively to 6.0±1.9 at the latest follow-up. Pre-operative VAS was 8.4±1 with a significant improvement of 1.25±1 in the last postoperative follow-up. Fusion was achieved in all cases. Transient neurological deficit was found in 1 patient who became normal after 3 months. All patients had ASIA grade “E” at last follow-up. There were no significant intraoperative major complications in this group either, except a few minor complications. Conclusion: A greater degree of kyphotic correction (&gt;40°) can be obtained with a single pedicle subtraction osteotomy at the dorso-lumbar level with minimal neurological complications.

Kyphosis After Thoracolumbar Spine Fractures: WFNS Spine Committee Recommendations.

Thoracolumbar fractures change the biomechanics of the spine. Load distribution causes kyphosis by the time. Treatment of posttraumatic kyphosis is still controversial. We reviewed the literature between 2010 and 2020 using a search with keywords “thoracolumbar fracture and kyphosis.” We removed osteoporotic fractures, ankylosing spondylitis fractures, non-English language papers, case reports, and low-quality case series. Up-to-date information on posttraumatic kyphosis management was reviewed to reach an agreement in a consensus meeting of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The first meeting was conducted in Peshawar in December 2019 with WFNS Spine Committee members’ presence and participation. The second meeting was a virtual meeting via the internet on June 12, 2020. We utilized the Delphi method to administer the questionnaire to preserve a high degree of validity. We summarized 42 papers on posttraumatic kyphosis. Surgical treatment of thoracolumbar kyphosis due to unstable burst fractures can be done via a posterior only approach. Less blood loss and reduced surgery time are the main advantages of posterior surgery. Kyphosis angle for surgical decision and fusion levels are controversial. However, global sagittal balance should be taken into consideration for the segment that has to be included. Adding an intermediate screw at the fractured level strengthens the construct.