Transpedicular wedge osteotomy for treatment of kyphosis after L1 fracture using intraoperative, full rotation, three-dimensional image (O-arm)-based navigation: a case report.

There has been a large series in the literature reporting on results of osteotomy for the correction of kyphotic deformity secondary to post-traumatic thoracolumbar fracture. However, there are few reports on using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, transpedicular wedge osteotomy for the correction of kyphotic deformity in old thoracolumbar fracture. A 45-year-old woman with L1 old fracture, presented to us with a Cobb angle of 45 degrees. The preoperative standard anteroposterior, lateral views and computed tomography (CT) reconstructions revealed kyphotic deformity. After attaching the reference arc of the 3D-imaging system, the thoracolumbar spine was screened using an O-arm without anatomical registration. The location, angle and depth of osteotomy, as well as screw fixation were performed using a guide tube while referring to the reconstructed 3D-anatomical views. The surgery was successful without nervous and vascular injuries. Using intraoperative, full rotation, three dimensional image (O-arm)-based navigation, the transpedicular wedge osteotomy is a safe and effective treatment for kyphosis after the thoracolumbar fracture, which can insert the pedicular screw accurately, trace the real-time wedge osteotomy and reduce the loss of correction of kyphotic deformity.