Mid-term clinical outcomes of posterior shift combined with rotational osteotomy at distal subapical vertebra in the treatment of severe angular kyphosis

English Keywords:Angular kyphosis  Subapical vertebra  Posterior shift combined with rotational osteotomy

English Abstract:

  【Abstract】 Objectives: To assess the midterm efficacy of distal subapical vertebra posterior shift combined with rotational osteotomy for severe angular kyphosis correction. Methods: A retrospective analysis was conducted on the clinical data of 35 patients with severe spinal angular kyphosis who underwent posterior shift combined with rotational osteotomy at distal subapical vertebra in our department from October 2016 to May 2022. There were 23 males and 12 females, the average age was 30.8±12.4 years(15-61 years), with 13 cases combined with nerve damage. Follow-up duration ranged from 2 to 6 years(mean 3.5 years). Full-length anteroposterior and lateral X-ray examination of the spine in a standing position was performed before operation, immediately after orthopedic surgery, and at 2-year follow-up, and the kyphotic angle, sagittal vertical axis(SVA), as well as sagittal apex deviation were measured and evaluated. The recovery of neurological function was evaluated by the Frankel classification of neurological function before operation, and at 2 weeks and 6 months after operation. Results: All 35 patients successfully underwent the surgery, resulting in a significant decrease in the kyphotic Cobb angle from 104.6°±13.2° preoperatively to 32.1°±18.4° postoperatively(P<0.05), with an improvement rate of 69.3%. Additionally, the SVA decreased from 4.9±4.4cm before surgery to 2.6±1.5cm after surgery immediately(P<0.05), and the sagittal apex deviation decreased from 10.9±2.0cm to 5.5±1.4cm(P<0.05). Furthermore, 12 out of the 13 patients with nerve damage showed improvement at the final follow-up assessment, 1 case showed no change compared with that before operation. Conclusions: Posterior shift combined with rotational osteotomy at distal subapical vertebra in the management of severe angular kyphosis can yield favorable orthopedic outcomes, which serves as a novel surgical option for managing severe angular spinal kyphosis.