Comparison of the efficacies of bilateral spinal joints release orthopedics and pedicle subtraction osteotomy in the treatment of rigid post-traumatic thoracolumbar kyphosis

English Keywords:Rigid post-traumatic thoracolumbar kyphosis  Pedicle subtraction osteotomy  Bilateral spinal joints release  Orthopedics  Outcomes

English Abstract:

  【Abstract】 Objectives: This study aimed to investigate the early clinical efficacies of bilateral spinal joint release(SJR) and pedicle subtraction osteotomy(PSO) in treating rigid post-traumatic thoracolumbar kyphosis(RPTK). Methods: 45 patients with RPTK who underwent either SJR or PSO at the Affiliated Hospital of Southwest Medical University between January 2016 and June 2022 were retrospectively analyzed. The patients were divided into SJR group(n=25; 13 males, 12 females; Apical vertebrae distribution: T11 in 4 cases, T12 in 10, L1 in 10, L2 in1) and PSO group(n=20; 9 males, 11 females; Apical vertebrae distribution: T11 in 4, T12 in 6, L1 in7, L2 in 3). There wasn′t statistical difference in gender, age, body mass index, disease duration, follow-up period, or apical vertebral distribution between the two groups(P>0.05). The number of fixed segments, operative time, intraoperative blood loss, postoperative drainage volume, intra- and post-operative complications were collected and compared between the two groups. The visual analogue scale(VAS) of low back pain and Oswestry disability index(ODI) were collected and evaluated before operation, at 14d, 3 months, and final follow-up after operation. American Spinal Injury Association(ASIA) grades, SF-36 physical component score(PCS) and SF-36 mental component score(MCS) were evaluated for neurological function and living quality before operation, at 3 months and final follow-up after operation. The imaging parameters such as global kyphosis(GK) Cobb angle, GK correction rate, and thoracolumbar kyphosis(TLK) were recorded and compared before operation, at postoperative 14d, 3 months, and final follow-up between the two groups. Results: All patients successfully completed the operation, and there was 1 case of dural rupture and 1 case of intercostal neuralgia in both SJR group and PSO group, and no other complications occurred. The operative time, intraoperative blood loss and postoperative drainage volume were 261.2±43.5min, 446.0±144.1mL, 292.3±99.0mL in the SJR group, and 326.5±68.4min, 1166.0±390.1mL, 505.8±99.2mL in the PSO group, respectively. SJR group was shorter in operative time, less in intraoperative blood loss and postoperative drainage volume than PSO group(P<0.05). There was no statistical difference in the number of fixed segments between the two groups(P>0.05). The low back pain VAS score and ODI of the two groups at 14d, 3 months, and final follow-up after operation were significantly lower than those before operation(P<0.05), and there was no statistical difference between the two groups at each time point(P>0.05). The PCS and MCS were significantly increased in both groups at 3 months after operation and at final follow-up. The PCS was higher in the SJR group(51.3±3.9) than that in the PSO group(46.2±5.0) at 3 months after operation(P<0.001). There was no significant difference in GK and TLK between the two groups before operation, which decreased at 14d, 3 months and final follow-up after operation in both groups(P<0.05) and showed no statistical difference in intergroup comparisons at each time point. There was no significant difference in GK correction rate between the SJR and PSO groups at each follow-up time point(P＞0.05). Conclusions: Both SJR and PSO can achieve satisfactory early clinical outcomes in the treatment of RPTK, while SJR technique is shorter in operative time, less in intraoperative blood loss and postoperative drainage, and better in early postoperative improvement of SF-36 scale score.