Posterior Grade 4 Osteotomy With Vertebral Shortening Is Effective for the Treatment of Kyphosis Associated With Vertebral Discitis/Osteomyelitis

Background In the retrospective study of a prospectively maintained database, we present a case series of patients with kyphotic deformity secondary to spinal infection treated using a posterior-only approach with 3-column shortening and posterior instrumentation.

Methods This is a case series of patients presenting with postural deformity and sagittal imbalance treated consecutively by 1 surgeon between 2012 and 2014. Clinical assessments and radiographic evaluations were made preoperatively and at 12- and 24-month postoperative follow-ups. All patients underwent computed tomography 24 months after surgery to evaluate spinal fusion.

Results The study included 5 patients with a mean age of 50 years (range, 32–60 years). Three patients had comorbidities. Three patients were classified as American Spinal Injury Association (ASIA) grade C and were not ambulatory; 2 were ASIA grade D. At follow-up, all patients were ambulatory and classified as ASIA grade E. Kyphosis was corrected from a preoperative mean of 32° (range, 15°–58°) to 10° (range, 1°–42°) at the 2-year follow-up. A mean improvement of 22° and 75% reduction in kyphosis was obtained with fixation 2 levels above and below the lesion. Interbody fusion was observed in all patients. No major complications occurred during surgery.

Conclusions Posterior grade 4 osteotomy with vertebral shortening can be performed safely in patients with kyphosis associated with vertebral discitis/osteomyelitis in the thoracolumbar region. The single approach allowed the surgeon to debride the infection, correct the kyphosis, decompress the spinal canal, and stabilize the spine.

Level of Evidence 4