SURGICAL APPROACH TO POSTTRAUMATIC THORACIC KYPHOTIC DEFORMITY

Abstract

Objective. To define the effective surgical management of posttraumatic kyphotic deformities in the thoracic spine basing on experimental biomechanical and clinical studies Material and Methods. Experimental biomechanical study was performed in 30 spine specimens. Anterior wedge osteotomy and fixation of a specimen in a kyphotic position modeled kyphotic deformity. Deformity correction with various instrumentation systems was firstly performed by maximal extension of segments adjacent to kyphosis-producing block, and carried on after crossing of intervertebral anatomical structures. Clinical study consisted in X-ray and instrumental examinations of 80 patients operated on for thoracic spine trauma. The magnitude of true posttraumatic deformity was defined as a difference between measured Cobb angle and mean physiological kyphosis value in the studied spine level. Results. Deformity rigidity, character of spine mobilization at the level of correction and size of posttraumatic deformity are the most significant factors determining the efficacy of thoracic posttraumatic kyphosis correction. The study resulted in defining rational approach to surgical correction of posttraumatic deformities in the thoracic spine. Conclusion. Minor kyphotic deformities in the thoracic spine are effectively corrected by instrumentation without mobilization of the spine. Large unfixed kyphosis sometimes requires anterior mobilization. Cases with rigid posttraumatic kyphotic deformity should be operated on with combined mobilization of the spine.