- Discussion:
- commonly results from:
-
frx of throracolumbar spine treated non-operatively,
esp when posterior
ligamentous complex has been disrupted;
- fractures treated by laminectomy w/o fusion (or w/ failed fusion);
-
children who have had extensive laminectomies, esp when facet
excision is included;
- prophylactic arthrodesis of the thoracic spine should be considered
at the time of extensive laminectomy;
- Post Laminectomy Kyphotic Deformity:
- progressive deformity from prior wide laminectomy;
- laminectomy in children is followed by high risk deformity (90%);
- preservation of at least one half of each facet is recommended when
possible;
- if it is not possible to preserve one whole facet or one half of
each facet, arthrodesis is indicated;
- fusion using pedicle screw fixation is best for reconstruction in
adult lumbar spine;
- Clinical Findings:
- pain at the fracture site
- occassional radiating leg pain and/or neurologic dysfunction;
- Indications for Surgery:
- thoracolumbar kyphosis;
- increasing kyphotic deformity;
- pain;
- increasing neurologic deficit;
- Surgical Planning:
- determine whether kyphosis is flexible or rigid;
- consider somatosensory evoked potentials;
- use intra-opeartive traction (Gardner Wells tongs);
-
halo fixator is used for 6 weeks postoperatively;
- Surgical Options:
-
posterior decompression;
- mentioned only to be condemned;
- posterior decompression will not allow spinal cord migrate away
from anterior compressing structures in kyphotic position;
-
anterior corpectomy and strut-grafting;
- lateral borders of the vertebral body must
be preserved;
- for two disc levels, iliac-crest strut graft is adequate;
- for more than two levels, fibular strut graft is superior;
- for defects longer than seven cm, vascularized fibular strut
graft may be advantageous;
-
combined anterior and posterior approaches w/ instrumentation &,
fusion and possibly combined osteotomies (for severe deformities);
- posteriorly consider use of facet fusion or facet plates;
-
kyphosis w/ spondylosis (posterior compression)
- combined anterior and posterior decompression are indicated;
- anterior corpectomy w/ fibular strut-grafting are recommended;
- to decompress the cord adequately, trough should be at least 16 mm;
-
w/ paralytic deformity:
- two stage treatment is often recommended;
- initial anterior decompression is followed by posterior stabilization;
- decompressive laminectomy should not extend cephalad of L2
in order to avoid promoting further kyphosis;
- facet joints must be maintained for spinal integrity;
-
postoperative treatment:
- postoperative use of
halo immobilization will help prevent
- graft dislodgment;
- spinal malalignment;
- pseudarthrosis;
- w/ multilevel surgery, plan to keep patient intubated until there is no
chance of excessive postoperative laryngeal swelling;
- w/ high cervical fusions, consider tracheostomy;
-------------------------------
Anterior stabilization, instrumentation, and decompression for
post-traumatic kyphosis.
Vascularised rib grafts for stabilisation of kyphosis.
Post-traumatic kyphosis. A review of forty-eight surgically treated patients.
