Posterior column resection followed by extension and middle column compression for thoracolumbar severe osteoporotic vertebral compressive fractures combined with kyphosis

English Keywords:Severe vertebral compressed fracture  Kyphosis  Osteoporosis  Posterior column resection  Middle column compression

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical outcome and safety of posterior column resection plus middle column compression for thoracolumbar kyphosis caused by severe osteopororotic compressive vertebral fractures. Methods: From July 2009 to January 2012, 14 patients suffering from thoracolumbar kyphosis caused by severe osteopororotic compressive vertebral fractures were treated with posterior column resection followed by extension and middle column compression. There were 2 males and 12 females with an average age of 68 years(range, 62-81 years). All the fractured vertebral located at T11-L2, 12 patients had one vertebral involvement and 2 had two levels. The rate of loss of vertebral height ranged from 78.5% to 92.4%(mean, 82.5%). The apical vertebral located at L1 in 7 cases, T12 in 5 cases and L2 in 2 cases. The mean preoperative kyphosis Cobb angle was 45°(range, 39°-59°). The distance between the C7 plumb line and the center sacral line was 1.6cm on average(range, 0.4-2.8cm). The preoperative lumbar lordosis was 41°-62°(mean, 58.4°), of them, 9 cases had compensatory lumbar lordosis. All the 14 patients presented with low back pain with an average preoperative visual analogue score(VAS) of 8.5(range, 7.5-9). According to Frankel classification, there were 12 grade E and 2 grade D. 10 patients underwent bone cement augmentation surgery. Results: The average surgical time was 190 minutes(range, 187-221 minutes). The average blood loss was 420ml(range, 372-463ml). The dura tearing occurred in 1 case. The postoperative average thoracolumbar kyphosis Cobb angle was 5°(range, 0-9°) with a 88.9% correction rate and the sagittal imbalance was corrected to 0.3cm(range, 0-0.8cm). The postoperative lumbar lordosis ranged from 28° to 43°(mean, 37°). The mean follow-up period was 21 months(range, 12-33 months). The average thoracolumbar kyphosis Cobb angle was 7°(range, 0-11°). The sagittal imbalance was 0.4cm(range, 0-1.2cm). The lumbar lordosis ranged from 29° to 45°(mean, 39°). 2 patients with Frankel grade D had recovered to grade E. The average VAS score was significantly improved to 1.9(range, 0-3.5) after surgery. The back pain relieved completely in 11 patients and partially in 3 patients. Bony fusion was achieved in all patients with no instrument related complication. Conclusions: Posterior column resection followed by extension and middle column compression is a reliable treatment for thoracolumbar kyphosis caused by severe osteopororotic compressive vertebral fractures. It is simple and less invasive compared with transpedicular osteotomy, and can be used as an alternative in cases where PVP is not suited.