title: Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis.
abstract: OBJECTIVE
  Most thoracolumbar fractures have a good healing outcome with adequate treatment. However, posttraumatic thoracolumbar kyphosis can occur in a proportion of thoracolumbar fractures after inappropriate treatment, osteoporosis, or osteonecrosis of the vertebral body. There are several surgical options to correct posttraumatic thoracolumbar kyphosis, including anterior, posterior, and combined approaches, which are associated with varying degrees of success. The aim of this study was to assess the use of a modified closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis and to evaluate the radiographic findings and clinical outcomes of patients treated using this technique.
  
  
  METHODS
  Thirteen consecutive patients with symptomatic posttraumatic thoracolumbar kyphosis were treated using a modified closing wedge osteotomy. The mean patient age was 62 years. The kyphosis apex ranged from T-10 to L-2. The sagittal alignment, kyphotic angle, neurological function, visual analog scale for back pain, and Oswestry Disability Index were evaluated before surgery and at follow-up. RESULTS The mean preoperative regional angle was 27.4°, and the mean correction angle was 29.6°. Sagittal alignment improved with a mean correction rate of 58.3%. The mean surgical time was 275 minutes, and the mean intraoperative blood loss was 1585 ml. The intraoperative complications included 2 dural tears, 1 nerve root injury, and 1 superficial wound infection. The mean visual analog scale score for back pain improved from 6. 6 to 2, and the Oswestry Disability Index score decreased from 55.4 to 22.6 at the last follow-up. All patients achieved bony anterior fusion based on the presence of trabecular bone bridging at the osteotomy site.
  
  
  CONCLUSIONS
  The modified posterior closing wedge osteotomy technique achieves satisfactory kyphosis correction with direct visualization of the circumferentially decompressed spinal cord, as well as good fusion with less blood loss and fewer complications. It is an alternative method for treating patients with posttraumatic thoracolumbar kyphosis.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Dae-Jean
authors.initials: DJ
authors.lastname: Jo
authors.affiliation: Department of Neurosurgery, Spine Center, Good Medical Hospital, Guri; and.
authors.forename: Yong-Sang
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Sung-Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: Orthopedic Surgery, Spine Center, Kyung Hee University Hospital at Gangdong, Seoul;
authors.forename: Ki-Tack
authors.initials: KT
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Chunchon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Eun-Min
authors.initials: EM
authors.lastname: Seo
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000293:injuries*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D011859:Radiography; D016103:Spinal Fractures / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D016896:Treatment Outcome
keywords: AIS = American Spinal Injury Association Impairment Scale; AP = anteroposterior; ODI = Oswestry Disability Index; SPO = Smith-Petersen osteotomy; VAS = visual analog scale; deformity; modified posterior closing wedge osteotomy; posttraumatic thoracolumbar kyphosis; thoracolumbar fracture