Management of Post-traumatic Kyphotic Deformity of the Thoracolumbar Spine: The Dala Experience.
*Shobode MA, *Abubakar K, *Chiroma MM, *Mamman M, *Waheed TA, *Onuminya J. E., *Abubakar MK, *Ekundayo OO,**Salami OOA, *Ibraheem GH.
National Orthopaedic Hospitals, *Dala, Kano and **Igbobi, Lagos
Address for correspondence:
Dr MA Shobode,
Department of Clinical Services,
National Orthopaedic Hospital, Dala, Kano, Nigeria
Background: Posttraumatic kyphotic deformity often follows a neglected vertebral compression fracture particularly of the thoracolumbar or lumbar spine. The loss of anterior vertebral height (greater than 50%) with disruption of the posterior Osseo-ligamentous complex are responsible for the deformity. Surgery is indicated in patients with excess and unacceptable local/regional kyphosis, impairment of function, mechanical instability and painful adjacent compensatory deformities like thoracic hypo-kyphosis, lumbar lordo-scoliosis of hyper-lordosis.
Objective: To describe the peculiarities of this pathology, the need for surgery and its principles, the factors to consider in surgical planning and the outcome of treatment in our centre
Materials and Methods: We present our findings in a clinical audit of 18 patients between Jan 2016 and June 2018. They were aged 26 to 49 years. All were males. Records were retrieved from the surgical outpatient unit, the operating room and the surgical wards. Imaging studies (orthogonal plain radiographs, CT scan and MRI) were used in the initial assessment and measurement of kyphotic angle using the Gardner’s and Cobb’s methods. ASIA IS, ODI and EuroQol 5D were used as outcome measures. SPSS 17 was used to analyse data.
Results: 18 male patients aged 26 to 49 were reviewed. All presented late (average duration was 10 months) with fixed kyphotic deformities of the thoracolumbar spine with an average regional kyphotic angle of 300. 50% presented as ASIA B, 25% ASIA A, while ASIA C and D were 12.5% each. None had full functions. T11 (2) and T12 (4) were involved in 6 patients while L1 was involved in 10 patients. Surgical aims included restoration of sagittal balance by correcting local biomechanics and invariably the subjacent/superjacent compensatory deformities and decompression of neural tissues. 12 patients had single-stage posterior approach with anterior column support and posterior transpedicular Screw-Rod construct (transpedicular decancellation osteotomy- 5, Vertebral column resection – 7); 4 had single-stage combined anterior and posterior approach (5400 reconstructions with Smith Peterson Osteotomy, pedicle Screws- Rod construct and anterior corpectomy – 2; 3600 reconstructions with SPO, Pedicle Screws-Rod construct and anterior corpectomy). Mean ODI preoperatively was 46% with a significant improvement to 24% postoperatively.
Conclusions: Posttraumatic kyphotic deformities often complicate poorly treated or neglected thoracolumbar spine injuries. Restoration of sagittal balance is key.
Key words: Post-trauma, kyphotic deformity, thoracolumbar spine.