gms | German Medical Science

Objective: Pedicle Subtraction Osteotomy (PSO) is a recognized tool for the surgical correction of kyphotic spinal deformities.

We report on a 2-level columnotomy and transpedicular subtraction osteotomy with additive correction of thoracolumbar scoliosis using a double rod system in long thoracolumbar correction spondylodesis.

Methods: 17-year-old male patient with a kyphosis of 102° from Th9 to L2 and right-convex thoracolumbar scoliosis of 30° Cobb angle between Th10 and L4. In addition, preoperative coagulation diagnostics revealed Factor V Leiden and mild Von-Willebrand-Syndrome.

We performed a 2-level columnotomy and transpedicular subtraction osteotomy at Th11/T12 level with dorsal spondylodesis between Th6 and L4 with a double-rod system between Th10 and L1.

Intraoperative blood loss was 4300ml. There were 1100ml of autotransfusion. 6 FFPs and 3 gr fibrinogen were administered intraoperatively. The administration of erythrocyte concentrates could be omitted. For pain therapy, 2 peridural catheters were placed intraoperatively.

Results: Postoperative radiographs showed a reduction of kyphosis to 15 ° between Th9 and L2. The scoliotic deformity could be corrected to 1° Cobb between Th10 and L4.

Conclusion: The further peri- and postoperative course was uncomplicated, the patient was easily mobilized under physiotherapeutic supervision. On the 9th postoperative day, the patient was discharged from inpatient treatment.

2-level columnotomy and transpedicular subtraction osteotomy is an invasive treatment option to correct severe kyphotic deformities.