Circumferential Correction of Severe Thoracolumbar Kyphosis by Utilizing an Articulating Rod and Lateral Interbody Device: A Technical Note.

Abstract

Background: 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.

Clinical presentation: 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.

Conclusion: 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.

Clinical relevance: The use of an articulating rod for correction of complex TLKs may benefit patient outcomes and improve safety.

Level of evidence: 4: