Closing-opening vertebral column resection for thoracolumbar congenital kyphosis: technical note and case report.

PURPOSE

To describe the technique of closing-opening vertebral column resection (COVCR) in an adult patient with severe thoracolumbar kyphosis secondary to two adjacent posterior hemivertebrae.

BACKGROUND

COVCR is a rare technique as it can only be applied in a very specific deformity configuration.

METHODS

We report the case of a 26-year-old male who has been complaining of middle and low back pain for over 10 years with difficulties when walking for long distances. Full spine anteroposterior and lateral X-rays revealed a severe thoracolumbar kyphosis with an angulation of 95° between T10 and L1. CT scan confirmed the presence of two adjacent posterior hemivertebrae at the level of T11 and T12. MRI did not show any spinal cord anomalies.

RESULTS

The patient underwent a posterior resection of T11 and T12 vertebrae with instrumentation from T7 to L4. Through the use of a side-to-side domino connector, closing of the middle column and opening of the anterior column were achieved demonstrating a COVCR. No cage was inserted. Thoracolumbar kyphosis was corrected to 25°. He could walk on day 2 with a satisfactory clinical and radiological result at 2 years.

CONCLUSION

This is the first paper to describe the true COVCR as a surgical technique for the management of congenital thoracolumbar kyphosis. Such variation of VCR may be applied in the presence of a posterior hemivertebra where the configuration enables opening of the anterior column and closing of the middle column.