Management of posttraumatic kyphosis after thoracolumbar injuries

Spinal trauma is relatively common, and each year approximately 10,000 to 17,000 people in the United States will sustain a spinal cord injury, and approximately 150,000 to 160,000 will fracture their spinal column. Posttraumatic spinal deformity is a common potential complication of spinal injury and poses as the greatest challenge in spinal surgery. Successful treatment of posttraumatic spinal deformity is dependent on careful patient selection and appropriate surgical intervention. Surgery should be considered in the presence of significant or increasing deformity, increasing back and/or leg pain, "breakdown" at levels above or below the deformity, pseudarthrosis or malunion, and increasing neurological deficit. The goals of surgery should be to decompress the neural elements if neurological claudication or neurological deficit is present and to recreate normal sagittal contours and sagittal and coronal balance and to optimize the chances for successful fusion. These goals can be achieved through an all-anterior, all-posterior, or a combined anterior and/or posterior approach, assuming that close attention is paid to using the appropriate bone-grafting techniques, selecting technically sound segmental instrumentation, and providing appropriate biomechanical environment for maintenance of correction and successful fusion.