Combined Single Stage Anterior and Posterior Osteotomy for Correction of latrogenic Lumbar Kyphosis

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Abstract
Fifty-four patients were treated by a standardized single stage anterior opening wedge and a posterior closing extension wedge osteotomy for back pain associated with postoperative loss of lumbar lordosis (iatrogenic flat back syndrome). Presenting complaints were fatigue, pain and a stooped posture. Etiological factors were, in descending order of frequency, distraction instrumentation with the lower end at the L5 or S1 vertebra, thoracolumbar junction kyphosis greater than 15°, especially if associated with a hypokyphotic thoracic spine, and degenerative changes above and below a previous fusion. Kostuik-Harrington Instrumentation was used anteriorly for the opening wedge and Dwyer cables and screws together with a midline plate were used posteriorly for the closing extension osteotomy. Malunion occurred in three patients, one requiring recorrection. Pain relief occurred in 48 (90%). Neurological complications occurred in two patients, one with permanent deficient. Follow-up averaged 4 years. Average preosteotomy lordosis L1–S1 was 21.5° and was restored to 49° (equal to the lordosis before the initial surgery) for an average correction of 29°, (range 24° to 63°). Prevention of this complication can be accomplished by maintaining normal lordosis at the time of initial surgery

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