Surgical correction of kyphosis: posterior total wedge resection osteotomy in 32 patients.

BACKGROUND: Many surgical procedures have been developed for the treatment of kyphoscoliosis. We present our experience of one technique for posterior total wedge resection osteotomy, with clinical and radiographic results. This is a one-stage solution which results in a shortened posterior column and reduced tension on the spinal cord in rigid angular kyphosis. PATIENTS AND METHODS: Between 1990 and 2000, we treated 32 patients with rigid local kyphosis by posterior wedge osteotomy and instrumentation. The etiology was congenital malformation in 17 cases, infection in 11 and previous laminectomy in 4 cases. The osteotomy is performed at the apex of the kyphotic deformity and covers two vertebrae. The upper and lower borders of the osteotomy are right inferior to the transverse processes of the upper and lower vertebrae respectively. The apex of the posteriorly based triangular osteotomy is either at the anterior vertebral body or anterior longitudinal ligament. RESULTS: The mean preoperative angle of local kyphosis was 72 (25-112) degrees mainly at the thoracolumbar region, and it improved to a mean of 23 (0-48) degrees after an average follow-up of 57 (24-108) months. The mean preoperative sagittal plumbline imbalance of 5.5 (2-12) cm was improved to 1.2 (-2-3.5) cm postoperatively. The mean loss of correction since operation was 3.4 (0-11) degrees. Radiographically, solid anterior and posterior fusion was achieved in all patients by 6 months. 1 patient had irreversible paraplegia and 2 others had transient nerve root injury postoperatively. INTERPRETATION: 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. This is an effective one-stage procedure, especially for the treatment of sharp and rigid kyphosis.