Roles of Spinal Osteotomies on Correction of Post-Traumatic Thoracolumbar Kyphosis

Thoracolumbar (T-L) fracture may create focal kyphosis accompanied by altered sagittal alignment, instability and potential neurological deficits. Surgical intervention for post-traumatic T-L kyphosis aims to restore sagittal balance, release compromised neural structures, and to improve the symptoms related to the malalignment. It is best indicated when there is a progression of kyphotic deformity, and/or when there are new or progressive neurological deficits. A kyphotic deformity ≥ 30° is susceptible to persistent chronic pain in the kyphotic region and surgical correction is often required. Those with posterior ligamentous complex injury may also warrant surgical correction as there is a higher risk of kyphosis progression. A number of surgical procedures could be employed to correct post-traumatic T-L kyphosis. Spinal osteotomies are often needed to improve global, sagittal or coronal balance including in the late and fixed post-traumatic kyphosis. Based on different extent of focal kyphosis and global malalignment, surgical options may include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), disc-bone osteotomy (DBO), vertebral column resection (VCR) or closing opening wedge osteotomy (COWO). The type of spinal osteotomy utilized to correct post-traumatic T-L kyphosis should be chosen based on the severity of the deformity, the alignment of the spine, and the surrounding structures. In the meantime, potential complications should be reduced with novel techniques and proper constructs. When all associated factors are considered, surgical correction composing a suitable spinal osteotomy can be a beneficial and rewarding procedure for patients with post-traumatic T-L kyphosis. © 2023 World Scientific Publishing Company.