Pedicle subtraction osteotomy in the treatment of chronic, posttraumatic kyphotic deformity.

OBJECT Thoracolumbar fractures, treated operatively or nonoperatively, may cause painful kyphotic deformities over time. A pedicle subtraction osteotomy (PSO) is a single-stage posterior procedure designed to correct sagittal plane deformity. Although it was initially used to treat nontraumatic conditions, a PSO can be highly effective in chronic, posttraumatic fractures of the lumbar spine. In this report the authors review details obtained in the treatment of three patients with severe, posttraumatic spinal deformities. They describe the surgical technique used to correct the sagittal malalignments. METHODS All three patients were middle aged, and good bone mineral density had been demonstrated in each case preoperatively. After PSO, a mean 51 degrees improvement in sagittal alignment was achieved and maintained until a solid arthrodesis was documented in each case. Substantial improvements in pain relief and functional outcome were observed. A detailed, procedure-specific literature review was undertaken. CONCLUSIONS A PSO is a valuable tool to add to the armamentarium of neurosurgeons who treat patients suffering from painful posttraumatic deformity following fractures of the upper lumbar spine.