A 29-year-old woman came to the Kentucky Spine Institute with incapacitating middle and low back pain. Her problem began in October 1996 when she was involved in a high-speed motor vehicle accident in which she sustained a fracture at T9. This injury was treated at an outside institution by the use of a rigid orthosis. She experienced pain and a progressive deformity of her back. There were no neurologic symptoms.
Physical examination showed a marked kyphotic deformity of the lower thoracic spine with a compensatory lumbar hyperlordosis or "swayback." The findings of the neurologic examination were within normal limits.
Preoperative radiographs revealed a flexion/compression injury at T9 with 46º of measurable kyphosis between T8 and T10 (Figure 1).
Figure 1. Preoperative lateral radiograph (on 36-inch cassette) revealing 46° of kyphosis as measured from T8 to T10 and a compensatory lumbar hyperlordosis.
of this nature with more than 30º of residual local kyphosis
are a known cause of chronic midback pain and of low back pain as
the result of the compensatory lumbar hyperlordosis.
A two-stage correction of this residual deformity was performed. This procedure involved first a thracotomy and corpectomy of the T9 vertebral body. The space between T8 and T10 was distracted, and a titanium cage filled with autograft bone was placed into the space. Stage 2 of the procedure involved repositioning the patient and performing a posterior spinal fusion from T5 to T12, using hooks and rods to secure the fixation.
Postoperative radiographs taken with the patient in the standing position revealed 24º of kyphosis as measured from T8 to T10 (Figure 2). Thus, the procedure achieved approximately a 50% correction of the deformity. Final follow-up radiographs reveal maintenance of this correction.
Figure 2. Final follow-up radiograph revealing residual kyphosis of 24° from T8 to T10 with spontaneous correction of the lumbar hyperlordosis.
clinical result has been excellent. She has experienced excellent
resolution of the preoperative lower and middle back pain.