Abstract
Purpose
Pedicle subtraction osteotomy (PSO) was developed to achieve significant correction of a deformity. It was initially used to correct sagittal plane deformities associated with ankylosing spondylitis, but recently it has also been performed in patients with post-traumatic kyphosis. Our aim was to report a case of a floating spine after PSO for post-traumatic kyphosis.
Methods
A 50-year-old man was injured after a fall. He had a compression fracture at T12 and an open fracture of the right lower limb. Although he presented with focal back pain, his open fracture was treated first by surgical intervention. The T12 compression fracture was treated conservatively. One year later, he had lower limb numbness and muscle weakness. His imaging demonstrated focal kyphosis on T12 and spinal cord compression. The diagnosis was post-traumatic kyphosis, which was treated with PSO. We performed osteotomy at T12, discectomy and bone graft at T11–T12, and posterior fusion from T10 to L2.
Results
One year after PSO, we removed the instruments because he complained of pain around them and found complete bony union between T11 and T12. He immediately experienced worse pain and could not walk or stand for more than 10 min. Imaging showed a floating spine between T12 and L1. He underwent anterior fusion at T12–L1, after which his severe back pain disappeared.
Conclusions
This case points out a pitfall of PSO. Although it is a powerful tool for correcting an imbalanced spine, we should recognize its pitfalls and try to avoid them.
This is a preview of subscription content, log in via an institution to check access.
References
Smith-Petersen MLC, Aifranc OE (1945) Osteotomy of the spine for correction of flexion deformity un rheumatoid arthritis. J Bone Jt Surg Am 27:1–11
Van Royen BJ, De Gast A (1999) Lumbar osteotomy for correction of thoracolumbar kyphotic deformity in ankylosing spondylitis. A structured review of three methods of treatment. Ann Rheum Dis 58:399–406
Wilson MJ, Turkell JH (1949) Multiple spinal wedge osteotomy; its use in a case of Marie-Strumpell spondylitis. Am J Surg 77:777–782
Hehne HJ, Zielke K, Bohm H (1990) Polysegmental lumbar osteotomies and transpedicled fixation for correction of long-curved kyphotic deformities in ankylosing spondylitis. Report on 177 cases. Clin Orthop Relat Res 49–55
Scudese VA, Calabro JJ (1963) Vertebral wedge osteotomy. correction of rheumatoid (ankylosing) spondylitis. JAMA 186:627–631
Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 142–152
Lehmer SM, Keppler L, Biscup RS, Enker P, Miller SD, Steffee AD (1994) Posterior transvertebral osteotomy for adult thoracolumbar kyphosis. Spine 19:2060–2067
Thiranont N, Netrawichien P (1993) Transpedicular decancellation closed wedge vertebral osteotomy for treatment of fixed flexion deformity of spine in ankylosing spondylitis. Spine 18:2517–2522
Lazennec JY, Saillant G, Saidi K, Arafati N, Barabas D, Benazet JP, Laville C, Roy-Camille R, Ramare S (1997) Surgery of the deformities in ankylosing spondylitis: our experience of lumbar osteotomies in 31 patients. Eur Spine J 6:222–232
Gertzbein SD, Harris MB (1992) Wedge osteotomy for the correction of post-traumatic kyphosis. A new technique and a report of three cases. Spine 17:374–379
Zhang X, Zhang Y, Wang Z, Wang Y (2011) Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Trauma 71:209–216. doi:10.1097/TA.0b013e3181efc176
Buchowski JM, Kuhns CA, Bridwell KH, Lenke LG (2008) Surgical management of posttraumatic thoracolumbar kyphosis. Spine J 8:666–677. doi:10.1016/j.spinee.2007.03.006
El-Sharkawi MM, Koptan WM, El-Miligui YH, Said GZ (2011) Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Eur Spine J 20:1434–1440. doi:10.1007/s00586-011-1720-y
Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, Crawford CH 3rd, O’Shaughnessy BA, Buchowski JM, Chang MS, Zebala LP, Sides BA (2012) Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine 37:1198–1210. doi:10.1097/BRS.0b013e31824fffde
Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Jt Surg Am 86-A Suppl 1:44–50
Gelb DE, Lenke LG, Bridwell KH, Blanke K, McEnery KW (1995) An analysis of sagittal spinal alignment in 100 asymptomatic middle and older aged volunteers. Spine 20:1351–1358
Kokubun S, Ozawa H, Aizawa T, Ly NM, Tanaka Y (2011) Spine-shortening osteotomy for patients with tethered cord syndrome caused by lipomyelomeningocele. J Neurosurg Spine 15:21–27. doi:10.3171/2011.2.SPINE10114
Conflict of interest
The authors have no financial or competing interests to disclose in relation to this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Shigematsu, H., Koizumi, M., Iida, J. et al. Floating spine after pedicle subtraction osteotomy for post-traumatic kyphosis. Eur Spine J 23 (Suppl 2), 278–284 (2014). https://doi.org/10.1007/s00586-014-3298-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-014-3298-7