Anterior-Posterior Combined Surgery for Post-Traumatic Kyphosis Due to Thoracolumbar Spine Fracture

Most thoraco-lumbar spine fractures are easily recognized and promptly managed with prolonged immobilization or surgical fixation. If the initial treatment method is inadequate or the initial diagnosis is incorrect, late symptomatic kyphosis leading to pain can occur. The management of this deformity might be extremely challenging. Prior reports on anterior decompression focused mainly on the neurological recovery and not in improvement the deformity. This study examined the results of anterior and posterior combined surgery for those patients, particularly in the viewpoint of kyphotic angle correction.

Twenty-four patients had anterior release and bone graft surgery, which was followed by short segment posterior instrumentation. Of the 24 patients, 19 were male and 5 were female with an average age of 44.5 years. The fractures occurred at T10 in 2 patients, T11; 5, T12; 7, L1; 8, and T11, 12; 2. The interval between the fracture and surgery ranged from 4 months to 5 years. Surgical intervention was performed if the kyphotic deformity was more than 30° or there was chronic continuous pain in the kyphotic region. The average preoperative kyphotic angle was 30.7° (range 22 - 42°) and 5 patients had a neurological deficit. The transthoracic approach was performed to the T10, 11, and 12 vertebra lesions and a modified 11th rib approach was used for the L1 vertebra. After complete decompression of the pathologic disc, a tricortical autoiliac bonegraft was done and no anterior internal fixation was used.

There was an average improvement in the focal kyphotic angle from 30.7° prior to surgery to 9.2° after surgery, and a 11.5° focal kyphotic angle was maintained at the last follow-up. All 5 patients with a neurological deficit preoperatively, showed neurological recovery of 1 or more Frankel grade. Pain was present in all patients preoperatively, with 20 patients reporting pain in the back and leg, 4 in the back and buttocks. Of the 24 patients, 15 reported that their pain was completely relieved, 7 reported partial relief, and 2 showed no change. No patients reported a worsening of their pain worse. Three patients developed a partial bowel obstruction that was resolved with non-surgical supportive measures.

These results suggest that a significant improvement in the focal kyphotic angle can easily be obtained without a spinal osteotomy or a multi segment spine fixation. Late anterior decompression and posterior short segment fixation can provide favorable results for patients with post-traumatic kyphosis and late pain.