Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis.
METHODS
Retrospective review.


OBJECTIVE
To assess the effectiveness of apical lordosating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis (OK).


BACKGROUND
Current surgical options for OK involve a risk of complex surgery in elderly patients, graft problems (e.g., graft dislodgement, subsidence, pseudarthrosis), and instrumentation problems (e.g., adjacent-segment failure, implant pullout). A posterior-only approach was used to make the surgery less invasive and safer.


METHODS
A total of 26 consecutive patients (average age 71.5 years, range 65-81) with thoracic or thoracolumbar OK underwent ALO. Mean follow-up was 3.2 years (range 2.1-6.1). Radiographic studies, complications, and patient satisfaction were assessed.


RESULTS
Mean operating time was 137 minutes, and mean blood loss was 717 mL. In 8 patients with thoracic hyperkyphosis, mean Cobb angle was corrected from 82.7 degrees (range 75 degrees-97 degrees) to 25.8 degrees (range 18 degrees-30 degrees), indicating normal kyphosis. In 18 patients, thoracolumbar kyphosis of 56.3 degrees (range 47 degrees-71 degrees) was corrected to -1.8 degrees (range -11 degrees to 7 degrees). Sagittal imbalance was 12.1 cm before surgery and 4.9 cm afterward. Satisfactory correction was achieved in all patients, without anterior release. Local kyphosis was corrected to -9.1 degrees from 53.6 degrees, and mean vertebral kyphosis to -26.6 degrees from 17.7 degrees. In 17 patients with neurologic deficit, Frankel grades improved after surgery. No major complication occurred. All patients had improved pain, self-image, and overall satisfaction.


CONCLUSIONS
ALO and minimal segments fixation appear to hold promise for the treatment of thoracic or thoracolumbar OK, and may be safer with fewer complications. A larger series with more patients and surgeons is needed for confirmation.
Chang
Kao-Wha
KW
The Taiwan Spine Center, Department of Orthopaedic Surgery, Armed Forces Taichung General Hospital, Taiwan, Republic of China. iscspine@ms45.url.com.tw
Chen
Ying-Yu
YY
Lin
Chien-Chung
CC
Hsu
Hsiang-Lan
HL
Pai
Ke-Chun
KC
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D010027:Osteotomy / Q000295:instrumentation / Q000379:methods*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome