Double approach in thoraco-lumbar malunions

Thoracolumbar fractures (T11–L2) complicated by malunion often need surgery. In our hands two approaches are necessary for release and fusion. Correction is obtained by posterior bending in situ of a screw rod fixation. When the deformity is flexible, first we perform a posterior reduction and stabilization, and secondly an anterior approach for interbody fusion. When spine is rigid an anterior release with waiting bone graft is performed first followed by a second posterior reduction and stabilization. This strategy allows a real correction without the loss of correction in time. This technique is fast and safe as demonstrated in our series of 20 patients.