Selection of osteotomy in patients with thoracolumbar posttraumatic kyphosis secondary to old fracture

English Keywords:Pedicle subtraction osteotomy  Smith-Petersen osteotomy  Thoracolumbar vertebra  Posttraumatic kyphosis

English Abstract:

  【Abstract】 Objectives: To investigate clinical outcome of pedicle subtraction osteotomy(PSO) and Smith-Petersen osteotomy(SPO) for thoracolumbar posttraumatic kyphosis. Methods: From March 2006 to December 2012, a total of 47 cases with posttraumatic kyphosis undergoing surgery were retrospectively analyzed, including 32 cases of PSO and 15 of SPO according to various pathological features and deformity. All patients with old kyphosis of thoracolumbar presented with back pain. PSO in one level and SPO in two or three levels were performed. Radiologic assessment included pre-, post-operative and follow-up Cobb angle and SVA in X-ray films. The visual analogue scale(VAS) and Oswestry disability index(ODI) were evaluated before surgery and at follow-up. Results: Forty two of the forty seven patients were followed up by 8 months to 48 months(average, 29.4±7.8 months), including 29 cases of PSO and 13 cases of SPO. Cobb angle in PSO group decreased from 41.8°±10.5° preoperatively to 2.6°±1.2° postoperatively and increased to 3.2°±1.3° at final follow-up. The correction rate was 92.3%. Cobb angle in PSO group decreased from 40.2°±9.6° preoperatively to 4.9°±2.3° postoperatively and increased to 5.3°±3.5° at final follow-up. The correction rate was 86.8%. Significant differences were observed(P＜0.05) in Cobb angle at postoperation and at final follow-up comparing to that of preoperation in both groups. SVA in PSO group decreased from 5.0+4.1cm preoperatively to －0.6+2.2cm postoperatively and increased to 1.2+1.5cm at final follow-up. SVA in PSO group decreased from 3.5+2.2cm preoperatively to 0.8+0.6cm postoperatively and increased to 1.3+1.1cm at final follow-up. Significant differences were observed(P＜0.05) in SVA at postoperation and at final follow-up comparing to that of preoperation in both groups. The VAS and ODI improved significantly in both groups at follow-up(P＜0.05). 42 cases got bony fusion. Conclusions: The PSO and SPO can obtain substantially correction and clinical result for thoracolumbar posttraumatic kyphosis according to various pathological features and deformity.