Posterior osteotomy and mesh cage support for severe and rigid angular kyphosis complicated with neurologic deficits

English Keywords:Angular kyphosis  Posterior vertebral column resection  Complication

English Abstract:

  【Abstract】 Objectives: To evaluate the efficacy and safety of posterior osteotomy and mesh cage support for severe and rigid angular kyphosis complicated with neurologic deficits. Methods: From January 2006 to November 2009, 15 patients suffering from rigid angular kyphosis complicated with neurologic deficits underwent posterior osteotomy and mesh cage support in our institute. The mean Cobb angle of kyphosis was 112.8°, Sagittal vertical axis(SVA) was 30.4mm. According to Frankel grading system, 3 patients were classified as grade B, 4 as grade C, 8 as grade D. Frankel grade was measured before and after operation. The complications were recorded retrospectively. Results: The average surgery time was 331.4min (240-470min) and the average blood loss was 2096.7ml(1200-4000ml). The average follow-up time was 28.0 months(20-35 months). The post-op kyphosis was 42.4° with a correction rate of 64.1%, and the kyphosis was 44.5° at final follow-up, with a loss rate of 6.0%. The post-op average SVA was 10.4mm with a correction rate of 66.0%. A total of 5 complications occurred in perioperative period, including 3 neurological cmplications and 2 non-neurological cmplications. 1 case grading Frankel had changed from D to A achieved no recover till the final follow-up, another 2 cases Frankel grade had changed to normal by neurotrophic and hyperbaric oxygen therapy. Another 2 cases who observed in pleural effusion and local infection, they were healed with appropriated treatment. Bony fusion was achieved in all patients, there was no correction lose. Conclusions: Posterior osteotomy can ensure satisfactory correction and decompression to the spinal cord, however risk of neurological injury must be taken into consideration.