Shah Sumedh S, Bashti Malek, Daftari Manav, Boddu James, Dusseau Nathaniel B, Liounakos Jason, Urakov Timur
Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, USA.
Int J Spine Surg. 2025 May 12;19(2):168-172. doi: 10.14444/8723.
Surgical management of severe thoracolumbar kyphosis (TLK) is challenging due to the necessity of achieving adequate sagittal realignment without increasing operative risk or compromising hardware integrity. Performing large corrective maneuvers during deformity correction may increase the risk of neurological complications, especially when correcting hyperkyphosis in the distal thoracolumbar spine. The present article describes the first use of a custom-made articulating rod to manipulate a patient's severe TLK into extension in combination with the expandable lateral interbody device to achieve circumferential deformity correction.
A 38-year-old woman with a history of spinal trauma 10 years ago developed severe TLK (<70° angulation) after failed posterior spinal stabilization. Due to her debilitating neurological symptoms and profound sagittal deformity, we performed a T9 to L2 navigation-assisted posterolateral fusion followed by a circumferential kyphotic correction utilizing a custom-made articulating rod (Globus Medical, Inc., Audubon, PA) with an expandable device placed in prone-lateral position at T11 to T12. The use of an articulating rod enabled us to safely manipulate the thoracolumbar spine into extension prior to permanent rod fixation. We were able to achieve approximately 40° of thoracolumbar correction. No immediate or late (at 2-year follow-up) postoperative medical or hardware-related complications were reported.
The use of an articulating rod with prone-lateral placement of an expandable interbody device allowed for a high degree of circumferential thoracolumbar deformity correction in a patient with severe post-traumatic TLK. Our results indicated the technical feasibility and success of utilizing this treatment strategy for high-grade TLK without medical- or hardware-related failure.
The use of an articulating rod for correction of complex TLKs may benefit patient outcomes and improve safety.
严重胸腰椎后凸畸形（TLK）的手术治疗具有挑战性，因为需要在不增加手术风险或不损害内固定完整性的情况下实现充分的矢状面复位。在畸形矫正过程中进行大幅度的矫正操作可能会增加神经并发症的风险，尤其是在矫正胸腰段脊柱远端的后凸畸形时。本文描述了首次使用定制的可活动连接棒将患者严重的胸腰椎后凸畸形矫正至伸展位，并结合可扩张的椎间融合器以实现环形畸形矫正。
一名38岁女性，10年前有脊柱外伤史，在后路脊柱固定失败后出现严重胸腰椎后凸畸形（成角<70°）。由于其衰弱的神经症状和严重的矢状面畸形，我们先进行了T9至L2导航辅助的后外侧融合术，然后采用定制的可活动连接棒（Globus Medical公司，奥杜邦，宾夕法尼亚州）进行环形后凸畸形矫正，在俯卧位侧方T11至T12置入可扩张装置。使用可活动连接棒使我们能够在永久固定连接棒之前安全地将胸腰椎脊柱矫正至伸展位。我们实现了约40°的胸腰椎矫正。未报告术后即刻或晚期（2年随访时）与医疗或内固定相关的并发症。
使用可活动连接棒并在俯卧位侧方置入可扩张椎间融合器，可使一名严重创伤后胸腰椎后凸畸形患者实现高度的环形胸腰椎畸形矫正。我们的结果表明，采用这种治疗策略治疗重度胸腰椎后凸畸形在技术上是可行的，且不会出现与医疗或内固定相关失败的情况。
使用可活动连接棒矫正复杂胸腰椎后凸畸形可能有利于改善患者预后并提高安全性。
