Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion.
BACKGROUND
Many techniques have been described for the surgical treatment of rigid posttraumatic thoracolumbar kyphosis, but none is well adapted to the modified shape of the wedged vertebra.


OBJECTIVE
The study aimed to describe the modified closing-opening wedge osteotomy (MCOWO), a new osteotomy technique that adapts to the triangular shape of the wedged apical vertebra of the deformity.


METHODS
A retrospective assessment of the degree of correction before and after the MCOWO was carried out.


METHODS
Ten patients presenting rigid posttraumatic thoracolumbar kyphosis were enrolled in this study.


METHODS
We used preoperative and postoperative whole spine radiographs to assess the sagittal plane parameters, and computed tomography scan for measurement of the vertebral segment height at the osteotomy level, spinal cord length, aorta length, and fusion rate.


METHODS
Ten patients underwent the MCOWO at T12 or L1. The procedure involves removing the postero-superior triangular corner of the wedged vertebra and transforming it to a shape similar to a trapezoid.


RESULTS
The patients' mean age was 36.6±7.5 years, the mean time between the fracture and the surgery was 12.2±5.6 months, and the mean follow-up was 30.6±5 months. In all patients, statistically significant improvement was observed in the sagittal plane after surgery. The thoracolumbar angle improved from 52±6° preoperatively to 7.1±5.7° at the last follow-up. Mean osteotomy angle was 38.1±2.6°, mean spinal cord shortening was 1.2±0.2 cm, and mean aorta lengthening was 2.3±0.4 cm. All the patients showed complete fusion at 2 years, and none required revision surgery. Two patients presented a temporary unilateral weakness that recovered completely within 3 months after the surgery.


CONCLUSIONS
The MCOWO is an interesting procedure for patients with posttraumatic thoracolumbar kyphosis. The modified osteotomy is adapted to the modified shape of the compressed vertebra. Spinal cord shortening and aorta lengthening were well tolerated in all patients.
Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia. Electronic address: anouar.bourghli@gmail.com.
Anouar
A
Bourghli
Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France.
Louis
L
Boissière
Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France.
Jean-Marc
JM
Vital
Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia.
Mohamed Aiman
MA
Bourghli
Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia.
Khaled
K
Almusrea
Orthopedic and Spinal Surgery Department, Kingdom Hospital, Riyadh, 11671 Pobox 84400 Saudi Arabia.
Ghassan
G
Khoury
Orthopedic Spinal Surgery Unit 1, Bordeaux Pellegrin Hospital,Place Amélie Raba-Léon 33076 Bordeaux cedex, France.
Ibrahim
I
Obeid
D000328:Adult; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects / Q000379:methods*; D016103:Spinal Fractures / Q000150:complications / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects; D013904:Thoracic Vertebrae / Q000601:surgery
Aorta lengthening; Kyphosis; Sagittal malalignment; Spinal cord shortening; Spine osteotomy; Thoracolumbar fracture