Die dorsoventrale, “schließende” Korrekturosteotomie an der Brust- und Lendenwirbelsäule

Summary

Goal of Surgery

Restoration of the physiologic alignment of the spine.

Indications

Sharply angled thoracolumbar or lumbar kyphosis following trauma or extensive spondylodesis.

Kyphosis due to ankylosing spondylitis or congenital malformation.

Congenital scoliosis.

Contraindications

Poor general health.

Severe osteoporosis.

Positioning and Anaesthesia

Prone as customary for surgery of the spine.

Operating table allowing positional adjustments.

Endotracheal anaesthesia

Surgical Technique

Exclusive posterior approach.

Extensive laminectomy and wedge resection of the posterior and anterior parts of the spine without displacing the dural sack.

After closure of the osteotomy gap spondylodesis involving a few segments only using appropriate internal fixation methods.

Apposition of autogenous bone grafts.

Postoperative Management

Isometric exercises of trunk muscles.

Bed rest for 48 hours.

Abdominal support for 2 to 3 months. External immobilization with a brace is usually not necessary.

Gradual increase in activities with limited movements of the spine.

Possible Complications

Pedicle fracture

Screw avulsion.

Rent of the dura.

Epidural bleeding.

Postoperative haematoma.

Nerve root irritation.

Results

12 patients, 10 with a kyphosis, 1 with a kyphoscoliosis and 1 with a scoliosis were operated on between 1992 and 1993.

Follow-up of minimal 2, maximal 3 years. All osteotomies showed bony consolidation. No complications up to now, no loss of correction seen. Average correction achieved: 39.5° (see Table 1).