ABSTRACT

Introduction:

Anterior and posterior procedures are usually combined for the surgical treatment of severe, rigid and local kyphosis secondary to trauma, infection, congenital anomalies or failed surgeries. This study presents our technique, clinical and radiologic results with posterior total wedge resection osteotomy which is a one-stage solution resulting in shortened posterior column and decreased tension on spinal cord in rigid angular deformities.

Patients and Methods:

Between 1990 and 2010, 61 patients with rigid angular spinal deformities were surgically treated by posterior total wedge resection osteotomy and instrumentation. Etiology was congenital malformation in 37, infection in 13, ankylosing spondylitis in three, and previous laminectomy in eight patients. The osteotomy was performed at the apex of the deformity and covered two vertebrae. Upper and lower border of the osteotomy are right inferior to the transverse processes of the upper and lower vertebrae respectively. Apex of the posteriorly based triangular osteotomy is either at the anterior vertebral body or anterior longitudinal ligament.

Results:

The mean preoperative angle of local kyphosis for thoracal and thoracolumbar region was 67ο (25o-112o) and it improved to a mean of 220 (00-480) after an average follow-up of 109 (12-192)months. Themean preoperative angle of local kyphosis in lumbar region was 100 ((-430)- 700) and it improved to a mean of -120 ((-330)- 220). The mean loss of correction since operation was 2.80 (00-110). Radiologically solid anterior and posterior fusion was achieved in all patients by six months. One (1.6 %) patient had irreversible paraplegia postoperatively.

Conclusion:

Posterior total wedge resection osteotomy eliminates the need for anterior procedure. Posterior column shortening decrease potential neurologic deficit risk by eliminating tractional force on spinal cord. It is an effective one-stage procedure especially for the treatment of sharp and rigid angular spinal deformities.