title: Thoracic kyphotic deformity reduction with a distractible titanium cage via an entirely posterior approach.
abstract: OBJECTIVE
  Surgical correction of thoracic kyphotic deformity is often associated with significant surgical and neurological morbidity and unsatisfactory reduction of kyphosis, especially in patients who cannot tolerate anterior thoracic procedures because of associated comorbidity. We describe a technique in which kyphotic deformity of the thoracic and thoracolumbar spine is corrected, decompressed, and stabilized with a circumferential fixation construct from a lone posterior approach.
  
  
  METHODS
  We reviewed the radiographic and clinical outcomes of seven patients undergoing vertebrectomy via a bilateral modified costotransversectomy approach followed by posterior placement of a distractible cage, reduction of the deformity via cage distraction, and supplemental dorsal instrumentation. All patients possessed thoracic/thoracolumbar kyphosis; however, a transthoracic approach was thought to be high risk because of medical comorbidity.
  
  
  RESULTS
  Seven patients underwent this procedure for thoracolumbar kyphosis resulting from a spinal tumor, osteomyelitis, and fracture. Vertebrectomies were performed at T2-T3, T4-T5, T5-T6, T12-L1, and L1. The mean preoperative kyphosis was 28.6 degrees, the mean postoperative kyphosis at the time of the final follow-up examination was 12.1 degrees, and the mean change in kyphosis was 53%. The mean long-term follow-up period was approximately 16 months. At the time of the final follow-up examination for all patients, there was no decline in neurological function, and pain management consisted of minimal use of oral narcotics.
  
  
  CONCLUSIONS
  This technique allows for circumferential decompression of the spinal cord via a posterior approach in patients with thoracic kyphotic deformities who cannot tolerate anterior thoracic approaches. In addition, in situ distraction of the expandable cage allows correction of sagittal imbalance and restores height without the potential loss of spinal height associated with osteotomies.
authors.affiliation: Department of Neurological Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. dsciubb1@jhmi.edu
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Graeme F
authors.initials: GF
authors.lastname: Woodworth
authors.forename: Ira M
authors.initials: IM
authors.lastname: Garonzik
authors.forename: Timothy
authors.initials: T
authors.lastname: Witham
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008488:Medical Illustration; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D019736:Prostheses and Implants; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D014025:Titanium / Q000627:therapeutic use; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014025:Titanium