Post-traumatic Kyphosis 5 Years After Motorbike Accident

History

The patient is a 49 year-old male, who works as a security guard.  Five years prior to presenting, the patient was involved in a motorcycle accident, resulting in a dorsal vertebral fracture, which was treated with a brace for 4 months.  Since then the patient reports intense pain and a progressive deformity.  The patient has no medical co-morbidities.

Examination

The physical examination showed the patient to have a kyphotic deformity in the dorsal spine, with a forward posture and head position, and with muscular paravertebral spasms.  There was no evidence of neurologic deficit, and the patient was coronally balanced.

Pre-operative clinical image of the patient.

Figure 1A: Pre-operative clinical image of patient.

Figure 1B: Pre-operative clinical image of patient.

Figure 1C: Pre-operative clinical image of patient.

Figure 2: Pre-operative radiographs show a burst fracture of T4, with 90% loss of height. Kyphosis from T3–T12 is 90-degrees. The posterior elements look intact.

Figure 3: Pre-operative sagittal CT demonstrates T4 fracture with canal compromise.

Figure 4: Pre-operative MRI shows no medullar compression.

Diagnosis

The patient was diagnosed with a T4 fracture, with post traumatic kyphosis and sagittal imbalance.

Selected Treatment

Posterior approach: T4 corpectomy, and posterior fixation T2–T12, correction of fracture and sagittal imbalance.

Outcome

At 6 months post-op, normal kyphotic curvature and sagittal plane balance has been restored.  The patient reports no pain, and is very satisfied.

Figure 5: Post-operative radiographs show T4 corpectomy and thoracic kyphosis reduced to 45-degrees.

Figure 6: Post-operative clinical images show optimal sagittal balance. Patient reports no pain.

Case Discussion

In the face of intense pain and progressive deformity, surgical correction is indicated. Spinal cord compression is created by acute kyphosis as opposed to retropulsion. If a pre-operative, lateral supine radiograph showed reduction of the kyphosis, the safest solution would have been posterior reduction and fixation alone. If the deformity was fixed, then the procedure performed, anterior decompression and fusion in conjunction with posterior fixation, was the best choice. This patient had an excellent outcome.