Expanded eggshell and closing-opening procedure of the treatment for thoracolumbar angular kyphosis

English Keywords:Kyphosis  Eggshell  Closing-opening procedure  Efficacy

English Abstract:

  【Abstract】 Objectives: To determine the efficacy of combined expanded eggshell and closing-opening procedure of the treatment for thoracolumbar kyphosis. Methods: Since December 2009 to February 2012, a total of 13 patients(8 males, 5 females) with thoracolumbar kyphosis(kyphosis cobb angle >60° was included in this study. 3 cases were diagnosed as failure of formation(type 1 deformity), 6 cases as old thoracic and lumbar compression fractures, and 4 cases as old spinal tuberculosis(including one case of T3-T5 vertebral malunion). Vertebral kyphosis located at T3-T5(n=1), T7/8(n=1), T8/9(n=1), T11/12(n=1), T12(n=4) and L1(n=5). 10 cases with the lesion segments at T11-L1 presented with serious back pain. The preoperative visual analog score(VAS) was 8.7±1.1(8-10). The remaining 3 kyphosis cases were associated with severe neurological deficit. The preoperative Frankel grade was C in 2 cases and D in 1 case. The average preoperative kyphosis Cobb angle was 67.3°(range, 62.0°-75.0°). Expanded eggshell combined with closing-opening technique was used for correction. Results: The average operation time was 400±60min and the average blood loss was 960±120ml. No neurovascular injury, dural tearing, pleural rupture, hemothorax or pneumothorax was noted during and after operation. The average local kyphosis Cobb angle was 20.3°±2.5°(18.0°-24.5°) and the average correction rate was 68.7%. All patients received more than 2 years of follow-up, with an average of 29.6 months(range, 24-36 months). During the follow-up, local kyphosis Cobb angle was 21.0° ±3.3°(19.0°-24.2°) without sagittal imbalance. The 3 cases with neurological deficit recovered from Frankle C to D in 1 case, C to E in 1 cases, and D to E in 1 case. Loss of correction, instrument failure and fracture were not observed. Conclusions: Expanded eggshell procedure combined with closing-opening technique is a safe and effective treatment for thoracolumbar kyphosis.