title: Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons.
abstract: METHODS
  Multinational survey of spine trauma surgeons.
  
  
  OBJECTIVE
  To survey a multinational group of spine trauma surgeons and develop an updated consensus definition of posttraumatic kyphosis (PTK), and the most current methods for diagnosis and treatment.
  
  
  BACKGROUND
  PTK remains a potential problematic sequela of thoracolumbar trauma. Although most surgeons have devised their own approaches for detecting and treating this condition, broad agreement in terms of the diagnosis and management of PTK has not been achieved. There is a lack of consensus-based guidelines, as the current literature largely consists of small case series or anecdotal expert opinions.
  
  
  METHODS
  A survey questionnaire was circulated among 35 multinational spine trauma surgeons. The questionnaire consisted of 29 questions divided into 8 domains: definition, diagnosis, risk factors, symptoms, radiographic evaluation, surgical indications, treatment, and expected outcome. Answers from respondents were compiled and evaluated to generate a consensus.
  
  
  RESULTS
  All 35 surgeons completed the survey. Consensus was achieved that PTK represents "a painful kyphotic angulation that can occur anywhere in the posttraumatic spine." Agreement was also reached that asymptomatic PTK can exist, although no true consensus could be reached on the extent of angular deformity that results in PTK. Untreated or maltreated flexion-distraction injuries, or severe burst fractures of the thoracolumbar spine, were felt to be the 2 injuries most likely to produce PTK. Computed tomography, magnetic resonance, and dynamic radiographs were all recommended for evaluation. If surgery is necessary, posteriorly based osteotomies, especially pedicle subtraction osteotomies, have become the principal means of correction.
  
  
  CONCLUSIONS
  An updated understanding of PTK and its treatment has been achieved. Posterior osteotomies seem to be the most popular means of surgical correction. In the future, multicenter prospective studies are necessary to ascertain, with greater precision, the most appropriate treatment for this condition.
authors.affiliation: Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA. ajschoen@neoucom.edu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Schoenfeld
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
authors.forename: Charles F
authors.initials: CF
authors.lastname: Fisher
authors.forename: Michael
authors.initials: M
authors.lastname: Fehlings
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
authors.forename: Kim
authors.initials: K
authors.lastname: Bouchard
authors.forename: Paul
authors.initials: P
authors.lastname: Arnold
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Lali
authors.initials: L
authors.lastname: Sekhorn
authors.forename: Mitchel B
authors.initials: MB
authors.lastname: Harris
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
mesh_terms: D006801:Humans; D007738:Kyphosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D010027:Osteotomy; D010146:Pain / Q000175:diagnosis / Q000209:etiology; D059408:Pain Management; D010147:Pain Measurement; D011859:Radiography; D013124:Spinal Injuries / Q000150:complications* / Q000628:therapy; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery; D011795:Surveys and Questionnaires