Posterior osteotomy way for thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture in elderly

English Keywords:Osteoporosis  Kyphosis  Ostectomy  Kyphosis correction

English Abstract:

  【Abstract】 Objectives: To investigate the clinical outcome of posterior osteotomy for thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture in elderly. Methods: From June 2005 to February 2011, a total of 22 elderly patients with thoracolumbar kyphosis caused by delayed osteoporotic vertebral fracture received transpedicular wedge osteotomy or trans-articular V shape osteotomy. There were 7 males and 15 fmales, with an average age of 66.5 years. A total of 30 vertebrae was involved, with 8 doubles and 14 singles. All patients presented with some extent of back pain, and the VAS score averaged 8.3(range, 6-9). Based on Frankle scale, there were 1 grade C, 6 grade D and 15 grade E. The kyphosis angle averaged 47.4°(range, 38°-54°). X-ray was taken before and after operation to observe Cobb angle. The soreness of patients was evaluated by VAS score and function of spinal cord was evaluated by Frankel grade. Results: 9 cases received operation of transpedicular wedge osteotomy while the other 13 cases received operation of trans-articular V shape osteotomy. The operation time was 190-260 minutes, 221 minutes in average, and the blood loss was 650-1400ml, 876ml in average. X-ray was taken 5 days after operation and Cobb angle was 3°-14°, 9.1° in average, which improved markedly than that before operation and the improvement rate was 79.5%. VAS score was 1-5, 4.2 in average, which markedly improved than that before operation. 2 cases changed from grade E to D after operation and recovered to grade E eventually after the treatment of nerve nutriment, while there was no deterioration in the other patients. All cases were followed up for 3 months to 62 months(average, 20.6 months). Cobb angle was 5°-22°, 12.5° in average. VAS score was 0-6, 4.2 in average. One case improved from grade C to D and 2 cases improved from grade D to E in Frankel degree, while there was no deterioration in the other patients. There was no instrument related complication related. There was an adjacent vertebral fracture upper the fixed segment 8 months after the operation in one case, and a second vertebral fracture upper the fixed segment 5 months after the operation in another case. The back pain were released in both cases after receiving symptomatic and anti osteoporosis treatment. Conclusions: Posterior approach for elderly patients with thoracolumbar kyphosis due to delayed osteoporotic vertebral fracture is effective and reliable.