POSTERIOR TRANSVERTEBRAL OSTEOTOMY FOR ADULT THORACOLUMBAR KYPHOSIS

Study Design. A retrospective case study was performed on the single-s tage posterior transvertebral closing-wedge osteotomy for treatment of adult thoracolumbar kyphosis. Summary of Background Data. Forty-one c onsecutive cases in 38 patients available for follow-up, averaging 33 months (range 4-87 months), are included. All patients had severe pain and/or deformity; 51% of cases had previous fractures, and 49% had po stlaminectomy failed back syndromes with kyphosis. A preoperative neur ologic deficit was present in 34% of the cases including two with caud a equina syndrome. Methods. Patient examination and interviews, subjec tive questionnaire, chart reviews, and radiographic measurements were performed independently. Complications, risks, benefits, results, and biomechanical considerations were evaluated and discussed as compared with other techniques. Results. All cases had solid-union at follow-up ; 93% maintained correction averaging 35-degrees with three requiring revision for failure. Postoperatively, 19.5% of the cases had new neur ologic deficits with five (12.2%) temporary or minor and three (7.3%) major, including one with unimproved paraplegia at follow-up. Eight of the 14 preoperative neurologic deficit cases improved postoperatively ; 26 additional surgeries were performed on 18 patients most commonly for pain (x 11) and additional trauma (x4). The subjective questionnai re results indicated significant patient satisfaction, with 76% statin g they would repeat the surgery and 90% recommending it to another. Co nclusion. This technically demanding high-risk procedure provides an e ffective and mechanically superior correction for acute angle thoracol umbar kyphosis in selected adult patients, with high subjective satisf action.