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

Introduction: 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 risk of neurological complications, especially when correcting hyper-kyphosis in the distal thoracolumbar spine. Here, we present the first use of a custom-made articulating rod to manipulate this patient’s severe TLK into extension in combination with expandable lateral interbody device to achieve circumferential deformity correction.

Methods: A 38-year-old female with history of spinal trauma ten years ago developed severe thoracolumbar kyphosis ( < 70 degree angulation) after failed posterior spinal stabilization. Due to her debilitating neurological symptoms and profound sagittal deformity, we performed a T9-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 T11-12.

Results: Use of articulating rod enabled us to safely manipulate the thoracolumbar spine into extension prior to permanent rod fixation. We were able to achieve approximately 40 degrees of sagittal thoracolumbar correction. No immediate or late (at two-year follow-up) post-operative 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 high degree of circumferential sagittal deformity correction in a patient with severe post-traumatic TLK. Our results indicated the technical feasibility and success utilizing this treatment strategy for high grade TLK without medical or hardware related failure.