TREATMENT OF THORACOLUMBAR CALLUS DEFORMITIS BY SIMULTANEOUS DOUBLE SPINAL APPROACH AND IN SITU CONTOURNING

Abstract

Purpose: We examined our preliminary results in a series of nine patients treated for thoracolumbar callus deformitis using a technique associating simultaneous anterior and posterior approaches and in situ contourning.

Material and methods: The series included seven women and two men, mean age 42 years operated on after January 2001. The patients had deformed callus after fractures (n=8) or spondylodiscitis (n=1). Surgical treatment was used initially for five of the fracture patients. The deformed callus involved the thoracolumbar junction in 56% of the patients. Mean follow-up was 14 months (6–22). The same surgical technique was used in all nine patients by two surgery teams. The patient was positioned in lateral decubitus. After posterior arthrectomy and anterior osteotomy, the correction was obtained by combined anterior distraction and lordosis contourning of the posterior material. An intercorporeal graft was encastrated anteriorly.

Results: Preoperative regional kyphosis was 30°. It was 4° postoperatively and 5° at last follow-up. Kyphosis improved in 87% of patients. There was no neurological aggravation. The main complication was posterior infection with aggravation of the regional kyphosis to 10° in one patient.

Discussion: Posterior or anterior spinal approach, alone or in combination have been proposed for callus deformitis of the spine. Results in the literature have shown moderate and incomplete correction of the kyphosis.

Conclusion: The proposed technique allows good reduction of the deformed callus with results that appear to persist with time.