Table 1 - uploaded by Anouar Bourghli
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Coronal and sagittal radiographic parameters
Source publication
Many techniques have been described for the surgical treatment of rigid posttraumatic thoracolumbar kyphosis, but none is well adapted to the modified shape of the wedged vertebra.
To describe the modified closing opening wedge osteotomy (MCOWO), a new osteotomy technique that adapts to the triangular shape of the wedged apical vertebra of the defo...
Contexts in source publication
Context 1
... standing radiographs were made the first time the patient stood up, then at 3 months after surgery, and at regular intervals until the last visit. For the preoperative, 3-month postoperative, and last follow-up images, a number of radiographic parameters were ana- lyzed (see Tables 1 and 2). For the parameters measured in the sagittal plane, the angle is considered negative if the cur- vature is lordotic and positive if the curvature is kyphotic. ...
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Objective:
To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK).
Methods:
From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at th...
Objective
To evaluate the prevalence of hidden neuraxial pathology (NAP) revealed in idiopathic scoliosis (IS) in neurologically normal patients.
Methods
We selected 401 patients with IS who visited our clinic. We identified patterns of NAP and its frequency. In addition to the main part of the study, we assessed the reliability of Magnetic Resona...
The spine provides structure and support to the body, yet how it develops its characteristic morphology as the organism grows is little understood. This is underscored by the commonality of conditions in which the spine curves abnormally such as scoliosis, kyphosis and lordosis. Understanding the origin of such spinal curves has been challenging in...
Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity. Methods : From July 2016 to January 2019, 12 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied. Results : Following PEO at T12 or L1, the mea...
Background: This is a retrospective study of the use of parallel endplate osteotomy (PEO) for correction of severe rigid thoracolumbar spine deformity.
Methods : From July 2016 to June 2017, 10 patients with severe rigid thoracolumbar spine deformity underwent PEO on T12 or L1 vertebrae were studied.
Results : Following PEO performed at T12 or L1,...
Citations
... This technique has been used for varied etiologies like tethered cord, Kummels disease, tuberculosis, and malunited fractures. [10][11][12][13][14] However, the literature on this technique's use in the acute trauma setting remains sparse. 9,[15][16][17] The purpose of this study was to: (1) to evaluate the radiological outcome (kyphotic angle progression) after IBF with SS-PSF in patients with acute unstable thoracolumbar fractures; (2) to evaluate the possible neurological improvement following the procedure; (3) to evaluate the safety of the procedure. ...
... 24 It has been extensively described in literature for various pathological conditions like Kummel's disease, tethered cord syndrome, and malunited fractures. [10][11][12][13][14] However, this procedure has been used quite sparingly in the setting of acute trauma 9,15-17 ( Table 1). ...
Background: Various operative procedures have been described for the treatment of traumatic paraplegia caused by unstable thoracolumbar fractures. We prospectively
evaluated interbody fusion (IBF) with SS-PSF in these cases with regard to clinico-radiological outcome with the objectives: (1) Does IBF and short segment
pedicle screw fixation (SS-PSF) prevent progression of kyphotic angle after surgery? (2) Can this procedure be safely performed in the setting of acute trauma?.
Methods: Sixteen patients suffering from traumatic paraplegia caused by acute unstable thoracolumbar fractures were enrolled prospectively and underwent IBF with
SS-PSF. They were evaluated for magnitude of shortening in spine, progression of kyphotic angle, and neurological improvement by American spinal injury association
scale (ASIA).
Results: Out of total sixteen, 14 patients were ASIA grade A and 2 were grade C, at the time of presentation. Thirteen out of these 14 remained grade A and one
improved to B. Both the patients who had grade C involvement at the time of presentation improved to grade D at one-year follow-up. The mean blood loss was 750
ml (range; 650 ml–1150 ml). Mean kyphotic angle decreased from 20.6◦ (range; 13◦ to 37◦) preoperatively to 6.2◦ (range; 3◦ to 10◦) at postoperative day 2 (p =
0.002). Its mean value after 6 months was 6.5◦ (range; 3◦ to 11◦). The procedure resulted in mean spinal column shortening of 18 mm (range; 16 mm–22 mm) in the
spinal column. All the patients achieved bony union by a mean duration of 3.9 months (range; 3 months–6 months).
Conclusions: IBF with SS-PSF has the shortest possible instrumented construct for thoracolumbar junction fusion done by posterior approach. The interbody fusion for
unstable thoracolumbar junction fractures prevents the progression of kyphotic angle post-operatively.
Level of evidence: Level 4.
... Osteotomy is necessary to achieve spinal correction, and commonly used strategies include spinous process (SP) osteotomy, Ponte osteotomy, pedicle subtraction osteotomy (PSO), and vertical column resection (VCR) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]; these strategies correspond to the Scoliosis Research Society grading system grades I-V, respectively. The incidence of operative time, bleeding, and complications increases with the increase of osteotomy grade. ...
... Thus, the technique in the study is not suitable for patients with nerve compression. For patients with rigid or combined anterior nerve compression or kyphosis Cobb angle still over 30° in the prone position, an anterior column osteotomy is required [13,16,24,37], including PSO, VCR osteotomy, etc. Although researchers have re ned these osteotomy techniques [11,12,14], threecolumn osteotomy often decreases spinal stability, and neurological complications, operation time, and complication rates increase. ...
Background
The current surgical options for late posttraumatic spinal kyphosis are primarily based on standing x-rays. The degree of deformity is reduced in the prone position. This self-correction of the deformity could be achieved without osteotomy or instruments, making large osteotomies no longer necessary. Osteotomy based on prone imaging data for the treatment of late posttraumatic kyphosis has not been reported. We, therefore, aimed to evaluate the clinical efficacy of simple posterior column osteotomy or non-osteotomy based on prone x-rays.
Methods
From April 2017 to November 2020, we collected preoperative standing, prone, postoperative, and final follow-up imaging data of 18 patients admitted to our hospital for late posttraumatic kyphosis using simple posterior column osteotomy or non-osteotomy. Preoperative prone data of thoracic kyphosis angle (TK), local kyphosis Cobb angle (LKCA), and lumbar lordosis angle (LL), was obtained. Preoperative, immediate postoperative, and final follow-up TK, LKCA, LL, sagittal vertebral axis (SVA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis angle (PI-LL) data was also obtained on standing x-ray imaging. The operative time, bleeding, and operative complication rate was collected and analyzed. We compared the preoperative, two month postoperative, and final follow-up Oswestry disability index (ODI) and visual analog score (VAS) scores to evaluate the surgical results.
Result
LKCA and TK significantly reduced from the standing to prone position before surgery. The LKCA, TK, and SVA of immediate postoperative and last follow-up data were statistically different compared with those before surgery; the differences in LL, PT, and PI-LL in the postoperative period and at the last follow-up were not statistically significant compared with those before surgery. All patients were operated upon successfully, with an operative time of 152.7 ± 34.2 min, a bleeding volume of 408.3 ± 135.3 ml, no complications of infection or nerve injury, and a decrease in ODI scores and VAS scores at two months and at the last follow-up (P < 0.05) after surgery.
Conclusion
Based on prone imaging, simple posterior column osteotomy or non-osteotomy surgery for traumatic kyphosis with good flexibility and no neurological symptoms is safe, with potential reduction in operative time, complications, and bleeding.
... In 2011, landmark paper by Wang et al. the authors' team (Zhang et al., 2011) reported a novel transpedicular technique for wedge resection of pedicle and extended rostral intervertebral disc managing posttraumatic kyphosis. In 2015, Berjano et al. (2015) and Bourghli et al. (2015) reported similar techniques correcting kyphotic deformities, while the fulcrum of the osteotomy closure was modified more dorsally for a larger correction angle. ...
... These two TIO techniques were then described as "bone disc osteotomy", "bone-disc-bone osteotomy", and "extended pedicle subtraction osteotomy" until Schwab defined it as "SRS-Schwab grade 4 osteotomy" in 2014, and the original schematic ( Fig. 9) of the landmark paper in 2011 was frequently cited as a "grade 4 osteotomy". In 2015, "corner osteotomy" by Berjano et al. (2015) and "modified closing-opening wedge osteotomy" by Bourghli et al. (2015) were introduced to address rigid thoracolumbar kyphosis. In 2018, Obeid et al. (2018) initially reported that "proximal thoracic PSO" was safely applied in the upper thoracic region of 10 patients. ...
... When inserting a cage, a disc spacer could be utilized to restore the height of the intervertebral disc space. Type III/III þ TIO can obtain over 30 correction and is indicated for rigid kyphosis with spinal column deficiency or malformation, such as congenital kyphosis/kyphoscoliosis, posttuberculosis kyphosis, posttraumatic thoracolumbar kyphosis (Huang et al., 2021;Zhang et al., 2011;Bourghli et al., 2015;Wang et al., 2008Wang et al., , 2009) and severe sagittal imbalance with thoracic hyperkyphosis (Obeid et al., 2018) or lumbar kyphosis (Berjano et al., 2015), especially severe ankylosing spondylitis kyphotic deformity (Wang et al., 2010;Zhao et al., 2015). Additionally, asymmetrical TIO (all types) in the coronal plane can also be directly performed to implement a three-dimensional deformity correction just filling the vacancy of systematic coronal plane correction in spinal osteotomy. ...
•This is a diagnostic study for a classification for posterior spinal osteotomy procedures via the intervertebral space.•Proposed a novel classification with excellent reliability and validity, differ from the SRS-Schwab osteotomy classification.•Give a novel definition of "trans-intervertebral osteotomy" (TIO) for posterior spinal osteotomy procedures.•Thoroughly discussed about the histories of posterior spinal osteotomy procedures via the intervertebral space.•Systematically introduced the TIO technique with fine original schematics.
... These techniques use posterior spinal shortening as a basic mechanism for a large correction angle. Therefore, over-shorting and redundancy of spinal cord are likely to occur, resulting in neurological deficits 3,15) . ...
Objective:
To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK).
Methods:
We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery.
Results:
The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation.
Conclusion:
Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.
... At 2.2-to 7.5-year follow-ups, this treatment decreased localized kyphosis from an average of 67-18°. Moreover, according to several studies, aorta lengthening and spinal cord shortening were well tolerated in all patients [29][30][31][32]. ...
... The spinopelvic parameters were: the C7-plumbline or the Sagittal Vertical Alignment (SVA) for sagittal balance; and the pelvic parameters such as the Pelvic Tilt (PT), Sacral Slope (SS) and Pelvic Incidence (PI) to assess compensation in the pelvis. 30,31,59,61 All parameters were measured on standing full spine lateral radiographs, including the hip joints and preferably the base of the skull. The C7-plumbline was described in 7 articles. ...
Study Design
Systematic Review.
Objective
To systematically analyze the definitions and descriptions in literature of “Spinal Posttraumatic Deformity” (SPTD) in order to support the development of a uniform and comprehensive definition of clinically relevant SPTD.
Methods
A literature search in 11 international databases was performed using “deformity” AND “posttraumatic” and its synonyms. When an original definition or a description of SPTD (Patient factors, Radiological outcomes, Patient Reported Outcome Measurements and Surgical indication) was present the article was included. The retrieved articles were assessed for methodological quality and the presented data was extracted.
Results
46 articles met the inclusion criteria. “Symptomatic SPTD” was mentioned multiple times as an entity, however any description of “symptomatic SPTD” was not found. Pain was mentioned as a key factor in SPTD. Other patient related parameters were (progression of) neurological deficit, bone quality, age, comorbidities and functional disability. Various ways were used to determine the amount of deformity on radiographs. The amount of deformity ranged from not deviant for normal to >30°. Sagittal balance and spinopelvic parameters such as the Pelvic Incidence, Pelvic Tilt and Sacral Slope were taken into account and were used as surgical indicators and preoperative planning. The Visual Analog Scale for pain and the Oswestry Disability Index were used mostly to evaluate surgical intervention.
Conclusion
A clear-cut definition or consensus is not available in the literature about clinically relevant SPTD. Our research acts as the basis for international efforts for the development of a definition of SPTD.
... The spine kyphosis deformity is mainly caused by congenial, tuberculosis, ankylosing spondylitis, fracture, etc. [1,2,[12][13][14][15][16][17]. The lumbar osteotomies are appropriate surgical techniques to improve the global sagittal balance of the spine, increasing the lumbar lordosis and decreasing the pelvic (lower PT) and the femoral (lower femoral exion) compensation. ...
... Ji et al. [11] reported that in case of osteotomy after the treatment of kyphosis, the length of the aorta was increased by 2.2 cm and the diameter of the aorta was decreased by 0.41 cm. Bourghli et al. [12] adapted a new surgical method of osteotomy to treat the angular kyphosis caused by fracture, and it was found that after surgery, the length of the aorta was increased by 2.3 cm. The above-mentioned studies indicated that due to elongation of the anterior column, the aorta may be stretched and vulnerable to injuries, especially in the elderly patients with reduced elasticity of the aortic wall. ...
... Since no obvious calci cation was observed in many cases, it therefore was not appropriate for all patients. Ji et al. [11] and Bourghli et al. [12] measured the length of the aorta between the instrumented vertebrate, and reported the changes in aorta. Although the aorta was xed with aortic hiatus and branch vessel, the position of the aorta shifted with the change of body, indicating that their method is inaccurate. ...
Objective: This study aimed to explore a new method for measuring the length of the aorta in patients with severe kyphotic deformity.
Methods: The computed tomography (CT) scan data of one patient with severe kyphotic deformity were retrospectively collected. The data were saved as Digital Imaging and Communications in Medicine (DICOM) format, and were imported into MIMICS software for processing. Then, the MASK function of the MIMICS software was used to mark the aorta in each slice of CT, and a three-dimensional (3D) reconstruction model of the aorta was established. After that, the length of the aorta was defined as the length of the centerline, which was calculated by the MIMICS. Besides, two points were fixed as anchor, and the length of aorta was acquired by measuring the distance between the two points. The proximal one was the origin of the left subclavian artery, and the fork was the distal of iliac artery. The length of the aorta was measured preoperatively and postoperatively as well.
Results: The 3D reconstruction model of the aorta was successfully established. It was revealed that the length of aorta was 418.9 mm preoperatively, and 435.4 mm postoperatively. The patient also underwent pedicle subtraction osteotomy (PSO). After orthopedic surgery, the length of the aorta was stretched by 16.5 mm.
Conclusion: In the present research, a 3D reconstruction model of the aorta was successfully established, and the length of the aorta was accurately measured without any invasive procedure. Using MIMICS software, the length of aorta in patients with severe kyphotic deformity could be effectively and precisely measured.
... This technique was described by Bourghli [15]. It is a closing-opening wedge osteotomy that includes resection of the disc above. ...
... The interest of performing closing-opening osteotomies (grades 3C and 4C) [8,9,15] is when a greater degree of correction is required from a single-level osteotomy (around 40°). Vertebral body should be intact to achieve a satisfactory anterior body opening in the case of a grade 3C, whereas in the case of a previously fractured vertebra with a wedge shape, the anterior column opening would be difficult to perform; therefore, it should be shifted proximally to the disc level by performing a grade 4C to achieve an anterior disc opening which simultaneously avoid resecting a significant amount of bone in a triangular body. ...
... Based on the approximate amount of correction achieved at a single level for each osteotomy grade according to the literature [5,7,8,12,14,15], a preoperative planning may be suggested. After thorough assessment of the patient global malalignment, an approximation of the required amount of correction at the apical level could be established (in relation to the ideal alignment correlated with the patient's pelvic incidence) [19]; If the amount of required correction is above 15°, in a non-flexible and rigid spine, therefore PSO or its modifications may be indicated with 3 categories to be identified, specifying the eventual suitable grades according to the correction needed: ...
Pedicle Subtraction Osteotomy classification
... 210 This procedure has been shown to reduce localized kyphosis from an average of 67-18°at 2.2-to 7.5-year follow-ups. 228 Ji et al. 206 and Bourghli et al. 229 have shown similar results; in addition, spinal cord shortening and aorta lengthening were well tolerated in all patients. ...
Ankylosing spondylitis (AS), a common type of spondyloarthropathy, is a chronic inflammatory autoimmune disease that mainly affects spine joints, causing severe, chronic pain; additionally, in more advanced cases, it can cause spine fusion. Significant progress in its pathophysiology and treatment has been achieved in the last decade. Immune cells and innate cytokines have been suggested to be crucial in the pathogenesis of AS, especially human leukocyte antigen (HLA)‑B27 and the interleukin‑23/17 axis. However, the pathogenesis of AS remains unclear. The current study reviewed the etiology and pathogenesis of AS, including genome-wide association studies and cytokine pathways. This study also summarized the current pharmaceutical and surgical treatment with a discussion of future potential therapies.
... Change in C7 SVA was 11 vs. 17 cm, osteotomy angle correction was 32° vs. 42°, and osteotomy height reduction was 1.3 vs. 0.7 cm. In 10 non-AS patients with posttraumatic kyphosis by Bourghli et al. [125], correction was av. 38°, spinal cord shortening av. ...
Introduction:
This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine.
Methods:
This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed.
Results:
Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented.
Conclusion:
The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.
