Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Jie ¹ , SU Bao ¹ , WANG Linbang ¹ , TANG Ke ¹ , LIU Ruixue ² ,  QUAN Zhengxue ¹

1. Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;
2. Graduate School of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

Keywords：

Osteoporotic vertebral compression fracture; kyphosis deformity; transvertebral space and under the pedicle osteotomy

DOI：

10.7507/1002-1892.202110014

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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). Conclusion Transvertebral 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.

Citation： QIN Jie, SU Bao, WANG Linbang, TANG Ke, LIU Ruixue, QUAN Zhengxue. Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 305-309. doi: 10.7507/1002-1892.202110014 Copy

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2.	李强, 李伟, 刘俊生, 等. 改良经椎弓根椎体截骨(PSO)治疗陈旧性胸腰椎骨折伴脊柱后凸畸形. 浙江创伤外科, 2013, 18(6): 882-885.
3.	袁华澄, 林晓毅, 游戊己. 胸腰段陈旧性骨折伴后凸畸形经椎弓根截骨矫形策略. 脊柱外科杂志, 2010, 8(4): 230-232.
4.	Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med, 2007, 147(5): 330-338.
5.	卜保献, 孙彦鹏, 吕振超, 等. 经椎间隙截骨矫形内固定治疗胸腰椎陈旧性骨折并后凸畸形. 中医正骨, 2012, 24(8): 41-42.
6.	Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int, 2005, 16 Suppl 2: S3-7.
7.	Scheyerer MJ, Simmen HP, Wanner GA, et al. Osteoporotic fractures of axial skeleton. Praxis (Bern 1994), 2012, 101(16): 1021-1030.
8.	陈仲强, 李危石, 郭昭庆, 等. 胸腰段陈旧骨折继发后凸畸形的外科治疗. 中华外科杂志, 2005, 43(4): 201-204.
9.	罗政. 后路椎间隙截骨矫形治疗脊柱后凸畸形. 中国中医骨伤科杂志, 2015, 23(12): 57-60.
10.	Xi YM, Pan M, Wang ZJ, et al. Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 1: S59-S66.
11.	徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2): 129-134.
12.	Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res, 1969, 66: 6-9.
13.	Diebo B, Liu S, Lafage V, et al. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S11-20.
14.	李波, 张铭华, 何盛江, 等. 经椎弓根椎体椎间隙截骨脊柱短缩术治疗脊柱后凸畸形. 中国骨与关节损伤杂志, 2009, 24(3): 237-239.
15.	江龙, 王强, 吴寅良, 等. 经椎间隙脊柱Ⅳ级截骨治疗陈旧性胸腰椎骨折伴后凸畸形的疗效分析. 中国骨与关节损伤杂志, 2021, 36(3): 264-265.
16.	王春国, 胡文浩, 李静, 等. 治疗脊柱畸形常用后路截骨术术式研究进展. 脊柱外科杂志, 2018, 16(6): 368-374.
17.	Su Y, Ren D, Zou Y, et al. A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. Clinics (Sao Paulo), 2016, 71(6): 297-301.
18.	Liu D, Zhong D, Cao AH. Use of computed tomography compression ratio in diagnosis of disc injuries and posterior ligamentous complex injuries in osteoporotic thoracolumbar compression fractures. Iran J Radiol, 2021, 18(4): e111779. doi: 10.5812/iranjradiol.111779.

1. Munting E. Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects. Eur Spine J, 2010, 19 Suppl 1(Suppl 1): S69-73.
2. 李强, 李伟, 刘俊生, 等. 改良经椎弓根椎体截骨(PSO)治疗陈旧性胸腰椎骨折伴脊柱后凸畸形. 浙江创伤外科, 2013, 18(6): 882-885.
3. 袁华澄, 林晓毅, 游戊己. 胸腰段陈旧性骨折伴后凸畸形经椎弓根截骨矫形策略. 脊柱外科杂志, 2010, 8(4): 230-232.
4. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med, 2007, 147(5): 330-338.
5. 卜保献, 孙彦鹏, 吕振超, 等. 经椎间隙截骨矫形内固定治疗胸腰椎陈旧性骨折并后凸畸形. 中医正骨, 2012, 24(8): 41-42.
6. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int, 2005, 16 Suppl 2: S3-7.
7. Scheyerer MJ, Simmen HP, Wanner GA, et al. Osteoporotic fractures of axial skeleton. Praxis (Bern 1994), 2012, 101(16): 1021-1030.
8. 陈仲强, 李危石, 郭昭庆, 等. 胸腰段陈旧骨折继发后凸畸形的外科治疗. 中华外科杂志, 2005, 43(4): 201-204.
9. 罗政. 后路椎间隙截骨矫形治疗脊柱后凸畸形. 中国中医骨伤科杂志, 2015, 23(12): 57-60.
10. Xi YM, Pan M, Wang ZJ, et al. Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 1: S59-S66.
11. 徐冠华, 崔志明, 李卫东, 等. 后路截骨矫形手术治疗老年骨质疏松性陈旧胸腰椎骨折伴后凸畸形. 中国脊柱脊髓杂志, 2013, 23(2): 129-134.
12. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res, 1969, 66: 6-9.
13. Diebo B, Liu S, Lafage V, et al. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S11-20.
14. 李波, 张铭华, 何盛江, 等. 经椎弓根椎体椎间隙截骨脊柱短缩术治疗脊柱后凸畸形. 中国骨与关节损伤杂志, 2009, 24(3): 237-239.
15. 江龙, 王强, 吴寅良, 等. 经椎间隙脊柱Ⅳ级截骨治疗陈旧性胸腰椎骨折伴后凸畸形的疗效分析. 中国骨与关节损伤杂志, 2021, 36(3): 264-265.
16. 王春国, 胡文浩, 李静, 等. 治疗脊柱畸形常用后路截骨术术式研究进展. 脊柱外科杂志, 2018, 16(6): 368-374.
17. Su Y, Ren D, Zou Y, et al. A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. Clinics (Sao Paulo), 2016, 71(6): 297-301.
18. Liu D, Zhong D, Cao AH. Use of computed tomography compression ratio in diagnosis of disc injuries and posterior ligamentous complex injuries in osteoporotic thoracolumbar compression fractures. Iran J Radiol, 2021, 18(4): e111779. doi: 10.5812/iranjradiol.111779.

Chinese Journal of Reparative and Reconstructive Surgery

Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture

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