POSTERIOR TOTAL WEDGE RESECTION OSTEOTOMY FOR SURGICAL TREATMENT OF RIGID KYPHOSIS
Journal Title: Journal of Turkish Spinal Surgery - Year 2002, Vol 13, Issue 1
Abstract
INTRODUCTION: Anterior and posterior procedures are usually combined for the surgical treatment of severe, rigid and local kyphosis secondary to trauma, infeetion, congenital anomalies, etc. In such cases a one-stage solution would be a posteriorly based, wedge-resection osteotomy which results in shortened posterior column and decreased tension on spinal cord. PATlENTS: Between 1990 and 1994, 20 patients with rigid local kyphosis were surgically treated by posterior wedge osteotomy and Cotrel-Dubousset instrumentation. Etiology was congenital malformation in 8, infection in 9 and previous laminectomy in 3 cases. OPERATIVE TECHNIQUE: The osteotomy is performed at the apex of the kyphotic deformity and covers 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. A complete laminectomy and facetectomy is performed at the posterior resection site and than lateral wall of the spinal canal is excised bilaterally. The spinal nerves are carefully dissected and preserved. Once the osteotomy and wedge resection are completed the left portions of the upper and lower vertebrae form an intervertebral foramen containing two spinal nerves on both sides at the resection site. RESULTS: The mean pre-operative angle of local kyphosis was 89° (range 60° -112°) and it improved to a mean ot 2.7 degrees ("range 20° -48°) postoperatively after an average follow-up of 64 months (range 4896). Fusion was achieved in all cases. Mean loss of correction at follow-up was 4° and one patient (5%) had postoperative neurologic deficit. CONCLUSION: Posterior total wedge resection osteotomy eliminates the need for anterior procedure and does not cause tractional force on the spinal cord since the posterior column is shortened. It is an effective one-stage procedure especially for the treatment of sharp and rigid kyphosis.
Authors and Affiliations
Ünsal DOMANIC, Ufuk TALU, Cüneyt SAR, Azmi HAMZAOGLU
Keywords
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