International Journal of Physical Medicine & Rehabilitation
Open Access

Abstract

Modified Decancellation Posterior Closing-Wedge Osteotomy for Correction of Traumatic Thoracolumbar Kyphotic Deformity: A Cadaveric and Preliminary Clinical Study

Zhang Jian-zheng, Liu Zhi, Han Li, Ren Ji-Xin and Sun Tian-Sheng

Study design: Cadaveric and clinical studies. Objectives: To investigate the safety and efficiency of modified decancellation posterior closing-wedge osteotomy for traumatic fixed kyphotic deformity of thoracolumbar spine. Methods: Single-level vertebral osteotomy was performed on two groups of fresh-frozen human cadaveric lumbar spines. Group I underwent conventional decancellation posterior closing-wedge osteotomy, and Group II underwent our modified cancellation posterior closing-wedge osteotomy. Sagittal plane angulation as well as anterior height and distance between the most cephalad and caudal endplate were measured before and after osteotomy. Twenty six cases of old thoracolumbar fractures with spinal cord injury were recruited in this study. The mean age was 35.6 years. The mean time from injury to operation was 25 months ranging from 3 months to 11 years. Prior to the index surgery, 9 patients received conservative treatment, and 17 patients underwent surgical treatment. There was complete paraplegia in 10 cases and incomplete paraplegia in 14 (Frankel B in 2 cases, C 10 and D 2). Two patients had no neurological deficit. All patients suffered from low back pain, the average score of Visual Analog Scale (VAS) was 4.5 (range 2.5-6.0). The patients were found to have a mean remaining kyphotic deformity of 35° (range 20°-75°). According to the deformity angles conventional or modified decancellation posterior closing-wedge osteotomy was performed. Results: The mean correction was 36° ± 3.6° for Group I and 49° ± 2.0° for Group II. The mean change in anterior height was only 2–4 mm for Group I and II. All cases were followed up for 10 months to 6 years with a mean of 12.5 months. Successful decompression and satisfied correction of kyphosis was noticed. The post-operatively mean angle of kyphosis deformity was 10.8°, ranging from 0° to 40°. Neurological function recovery was noted in 50% of cases. For complete spinal cord injury, 30% of cases had partial recovery (sensation) whereas recovery was observed in 64.3% of cases with incomplete spinal cord injury. The statistical difference between the groups was p<0.01. The mean score of visual analog scale (VAS) was 2.3 (range 1.0-3.5) at last follow-up. Conclusion: The fixed kyphotic deformity of thoracolumbar spine in traumatic spinal cord injury could be treated with conventional or modified decancellation posterior closing-wedge osteotomy. Neurological function recovery and alleviation of low back pain is expected.