Objective To assess the outcomes of pedicle subtration osteotomy and short-segment pedicle screw internal fixation in kyphosisdeformity. Methods From June 2001 to November 2003, 16 cases of kyphosis deformity were treated with pedicle subtration osteotomy and short-segment pedicle screw internal fixation, including 11 males and 5 females and aging 24-51 years. The kyphosis deformity was caused by ankylosing spondylitis in 12 cases, old lumbothoracic fracturedislocation in 2 cases, and vertebral dysplasia in 2 cases. The disease course was 7-25 years with an average of 12.8years. The whole spine radiographs were taken pre-and postoperatively. The sagittal balance was assessed by measuring thoracic kyphosis angle, lumbar lordosis angle, acrohorizontal angle and distance between posterosuperior point of S1and the vertical line. The clinical outcomes were assessed by Bridwell-Dewald scale for spinal disorders. Results The mean follow-up period was25.6 months. The mean bleeding was 1 100 ml. Satisfactory bone graft healing was achieved at final follow-up. Complications were paralytic intestinal obstruction in 1 case, dura laceration in 1 case, and temporary lower limb paralysis in 2 cases. Final follow-up radiograph showed an increase in lumbar lordosis angle from 9.6±16.4° to 42.6±14.3°(P＜0.05), whereas thoracic kyphosis angle remained relative stable. The distance between posterosuperior point of S1 and the vertical line was decreased from 97.5±45.6 mm to 10.7±9.6 mm(P＜0.05). Satisfactory clinical outcome was achieved by evaluating the changes of pain, social and working status. Conclusion Pedicle subtraction osteotomy and short-segment pedicle screw internal fixation is effective for correction of kyphosis deformity.
【摘要】 目的 探讨经后路全脊截骨联合椎弓根螺钉治疗胸腰椎脊柱后凸畸形的手术评估和临床疗效。 方法 2004年4月－2010年6月采用后路脊椎截骨椎弓根螺钉内固定治疗脊柱后凸畸形15例，其中男11例，女4例；年龄16~61岁，平均49岁。陈旧性胸腰椎骨折后凸10例，结核后凸3例，椎体发育不良2例；后凸顶点：胸9椎体1例，胸11椎体3例，胸12椎体4例，腰1椎体5例，腰2椎体2例。脊柱后凸Cobb角35~61°，平均46°。Frankel分级：E级2例，D级8例，C级4例，B级1例。 结果 术中出血800~1 800 mL，平均1 000 mL；术中1例左侧胸神经根损伤；1例术后双下肢肌力感觉减退。15例患者均获随访，随访时间10~30个月，平均12个月。术后6个月Cobb角5~10°，平均矫正率86.5%。术后6~10个月X线片显示截骨平面骨性愈合，术后神经功能恢复情况，除1例B级恢复至D级外，其余为E级。内固定物无松动、断裂和纠正度数丢失等并发症。 结论 经后路脊柱截骨联合椎弓根螺钉内固定具有减压、矫形同时进行，矫正度数大，并发症少，临床效果明显。【Abstract】 Objective To explore the surgery assessment and clinical outcome of the treatment for thoracolumbar kyphosis by whole posterior spinal osteotomy combined with pedicle screw. Methods Fifteen patients including 11 males and 4 females with kyphosis were treated by posterior spinal osteotomy combined with pedicle screw from April 2004 to June 2010. The age of them ranged from 16 to 61 years old averaging at 49. There were 10 cases of old thoracolumbar fracture kyphosis, 3 cases of tuberculosis kyphosis, and 2 cases of poor vertebral growth. As for kyphosis vertices, there were 1 case of T9, 3 cases of T11, 4 cases of T12, 5 cases of L1, and 2 cases of L2. Kyphosis Cobb angle ranged from 35° to 61°, averaging at 46°. Based on Franke Grade, there were 2 grade E cases, 8 grade D cases, 4 grade C cases, and 1 grade B case. Results Intraoperative blood loss was from 800 to 1 800 mL with an average of 1 000 mL; There was 1 case of left thoracic nerve root injury during operation and 1 case of lower extremity muscle strength hypoesthesia after operation. All the 15 patients were followed up for 10 to 30 months with an average time of 12 months. Six months after surgery, Cobb angle ranged from 5° to 10°, with an average correction rate of 86.5%. Six to ten months after osteotomy, X ray showed a good bone healing condition. As for the recovery status of neurological function after surgery, All patients recovered to grade E except 1 patient who returned to grade D from grade B. No such complications as fixation without loosening, fracture or loss of correction degree occurred. Conclusion In posterior spinal osteotomy combined with pedicle screw fixation, decompression and correction can be carried out at the same time to correct a large degree of kyphosis with few complications. The clinical effect is obvious.
ObjectiveTo explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle≥55°) and paraplegia. MethodsBetween January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23±7.95)°. The visual analogue scale score (VAS) was 7.38±0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases. ResultsHealing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38±1.76)° at 1 week and (22.15±1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre-and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08±0.76 at 1 week and 0.62±0.14 at last follow-up, showing significant differences between at pre-and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05). ConclusionOne-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.
Objective To investigate the effectiveness of transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 11 patients with thoracolumbar kyphosis caused by old OVCF treated by transvertebral space and under the pedicle osteotomy between January 2016 and December 2020 were retrospectively analyzed. There were 2 males and 9 females, with an average age of 61.3 years (range, 50-77 years) and with a median disease duration of 8 years (range, 6 months to 50 years). Fracture reasons: 9 cases had a clear history of trauma, and 2 cases had no obvious incentive. A total of 11 vertebrae was involved in fracture, including T12 in 3, L1 in 7, L2 in 1. The operation time, intraoperative blood loss, postoperative drainage volume, and complications were recorded. Full-length X-ray films of spine and local X-ray films of the operation area were examined before operation, at 7 days after operation, and at last follow-up. The Cobb angle of thoracolumbar kyphosis was measured, and the correction rate was calculated. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded to assess patients’ pain and functional improvement before operation, at 1 month after operation, and at last follow-up. Results All operations were successfully completed. The average operation time was 188.6 minutes (range, 140-215 minutes); the average intraoperative blood loss was 268.2 mL (range, 100-500 mL); the average postoperative drainage volume was 615.5 mL (range, 160-1 500 mL). One patient developed bilateral thigh rebound pain after operation, which relieved after symptomatic treatment of nutritional nerve and acesodyne. All patients were followed up 14.7 months on average (range, 6-56 months). At last follow-up, osseous fusion was observed in all patients, and no fracture, loose, or displacement of internal fixator was observed on imaging. At 7 days after operation and at last follow-up, the Cobb angle of thoracolumbar kyphosis significantly improved when compared with preoperative one (P<0.05), and there was no significant difference between at 7 days after operation and at last follow-up (P>0.05); the correction rates of Cobb angle at 7 days after operation and at last follow-up were 68.0%±9.8% and 60.3%±11.9%, respectively. At 1 month after operation and at last follow-up, the VAS score and ODI significantly improved when compared with preoperative ones, and further improved at last follow-up when compared with those at 1 month after operation, all showing significant differences (P<0.05). ConclusionTransvertebral space and under the pedicle osteotomy is an effective way to treat thoracolumbar kyphosis caused by old OVCF with less trauma, shorter operation time, and less intraoperative blood loss. Patients can obtain good orthopedic results and quality of life.