Combined single stage anterior and posterior osteotomy for correction of iatrogenic lumbar kyphosis

Fifty-four patients were treated by a standardized single stage anterior opening wedge and a posterior closing extension wedge osteotomy for back pain associated with postoperative loss of lumbar lordosis (iatrogenic flat back syndrome). Presenting complaints were fatigue, pain and a stooped posture...

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Bibliographic Details
Published in:Spine (Philadelphia, PA. 1976) PA. 1976), 1988-03, Vol.13 (3), p.257-266
Main Authors: KOSTUIK, J. P, MAURAIS, G. R, RICHARDSON, W. J, OKAJIMA, Y
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Disability Evaluation
Diseases of the osteoarticular system
Diseases of the spine
Equipment Design
Female
Humans
Iatrogenic Disease
Kyphosis - diagnostic imaging
Kyphosis - physiopathology
Kyphosis - surgery
Lumbosacral Region
Male
Medical sciences
Middle Aged
Orthopedic Fixation Devices
Osteotomy
Postoperative Period
Posture
Radiography
Spinal Fusion
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Summary:Fifty-four patients were treated by a standardized single stage anterior opening wedge and a posterior closing extension wedge osteotomy for back pain associated with postoperative loss of lumbar lordosis (iatrogenic flat back syndrome). Presenting complaints were fatigue, pain and a stooped posture. Etiological factors were, in descending order of frequency, distraction instrumentation with the lower end at the L5 or S1 vertebra, thoracolumbar junction kyphosis greater than 15 degrees, especially if associated with a hypokyphotic thoracic spine, and degenerative changes above and below a previous fusion. Kostuik-Harrington instrumentation was used anteriorly for the opening wedge and Dwyer cables and screws together with a midline plate were used posteriorly for the closing extension osteotomy. Malunion occurred in three patients, one requiring recorrection. Pain relief occurred in 48 (90%). Neurological complications occurred in two patients, one with permanent deficient. Follow-up averaged 4 years. Average preosteotomy lordosis L1-S1 was 21.5 degrees and was restored to 49 degrees (equal to the lordosis before the initial surgery) for an average correction of 29 degrees, (range 24 degrees to 63 degrees). Prevention of this complication can be accomplished by maintaining normal lordosis at the time of initial surgery.
ISSN:0362-2436
1528-1159