title: Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis.
abstract: 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.
authors: The Taiwan Spine Center, Department of Orthopaedic Surgery, Armed Forces Taichung General Hospital, Taiwan, Republic of China. iscspine@ms45.url.com.tw
authors: Kao-Wha
authors: KW
authors: Chang
authors: Ying-Yu
authors: YY
authors: Chen
authors: Chien-Chung
authors: CC
authors: Lin
authors: Hsiang-Lan
authors: HL
authors: Hsu
authors: Ke-Chun
authors: KC
authors: Pai
mesh_terms: 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