Delayed posttraumatic thoracolumbar spinal deformities: diagnosis and management.

Abstract

Approximately 50,000 traumatic injuries resulting in fractures of the bony spinal column occur annually in the United States. Although some of these lesions are clearly unstable and mandate urgent surgical treatment for stabilization, less severe injuries may be managed initially with bracing and serial imaging to evaluate bony healing and alignment. A proportion of these injuries will require delayed surgical intervention to correct a posttraumatic deformity. In addition, inadequate or ineffective acute spinal stabilization can also result in the progression of delayed spinal deformities. The management of these lesions is frequently complicated by scarring in the body cavities from the inciting trauma or any subsequent surgical interventions, epidural scar formation and spinal cord tethering, solid fusion into the deformed state, medical comorbidities associated with paralysis, and compromised spinal cord function. With these factors in mind, surgical management of these frequently kyphotic deformities can be performed via a posterior approach with osteotomies or a combined anterior approach and posterior procedures.