SRS-Schwab grade <b>Ⅳ</b> osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHANG Yinchang ¹ , ZHAO Qinghua ² , QIN Xiaodong ² , QIU Yong ² ,  ZHU Zezhang ²

1. Department of Orthopaedics, Yijishan Hospital, Wannan Medical College, Wuhu Anhui, 241000, P.R.China;
2. Department of Spinal Surgery, Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing Jiangsu, 210008, P.R.China;

Corresponding?author：

ZHU Zezhang, Email: zhuzezhang@126.com

Keywords：

SRS-Schwab grade Ⅳ osteotomy; kyphosis; thoracolumbar spine; old fracture; osteoporosis; satellite rod

DOI：

10.7507/1002-1892.201808022

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Objective To evaluate the effectiveness of SRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis.Methods Between April 2013 and August 2016, 20 cases of thoracolumbar old osteoporotic fracture with severe kyphosis were treated with SRS-Schwab grade Ⅳ osteotomy combined with satellite rod. All the patients were females, aged 49-71 years (mean, 54.8 years). The disease duration was 6-28 months with an average of 14 months. The T value of bone density was –4.4 to –1.8 (mean, –2.8). The preoperative Cobb angle was (43.0±11.3)°. The vertebral compression fracture segment was T₁₂ in 9 cases, L₁ in 8 cases, and L₂ in 3 cases. Preoperative spinal cord function was evaluated by Frankel classification; there were 5 cases of grade D and 15 cases of grade E. The operation time, intraoperative blood loss, and perioperative complication were recorded. The Cobb angle for kyphosis and sagittal vertical axis (SVA) were recorded beforeoperation, at 3 months after operation, and at last follow-up. Oswestry disability index (ODI) was used to evaluate the effectiveness before operation and at last follow-up, and the evaluation indicators included pain degree, daily life self-care ability, extracting, walking, sitting, standing, sleeping, social activities, and traveling.Results The operation time was 180-314 minutes (mean, 226 minutes). The intraoperative blood loss was 390-1 800 mL (mean, 750 mL). All the incisions healed by first intension without incision infection. Twenty patients were followed up 24-52 months, with an average of 30.9 months. During the follow-up period, no significant complication such as correction loss, nail breakage, rod breakage, pseudoarthrosis formation, or proximal and distal junctional kyphosis occurred. All patients were able to walk upright after operation, and the pain relieved significantly at 6 months after operation. Bone fusion achieved at 12 months after operation. The Frankel grade of nerve function improved from grade D to grade E at last follow-up in 5 patients with nerve damage before operation. At last follow-up, the indicator scores of ODI significantly improved when compared with preoperative values (P<0.05). Cobb angle significantly improved at 3 months after operation and at last follow-up (P<0.05) when compared with preoperative one, but there was no significant difference in the Cobb angles between 3 months after operation and last follow-up (P>0.05). There was no significant difference in SVA between pre- and post-operation (P>0.05).Conclusion SRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis is effective in achieving satisfactory clinical outcomes, as well as maintaining correction of kyphosis.

Citation： ZHANG Yinchang, ZHAO Qinghua, QIN Xiaodong, QIU Yong, ZHU Zezhang. SRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(3): 259-264. doi: 10.7507/1002-1892.201808022 Copy

1.	Saita K, Hoshino Y, Higashi T, et al. Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis. Spinal Cord, 2008, 46(1): 16-20.
2.	Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2015, 74(1): 112-120.
3.	邱勇, 朱澤章, 王斌, 等. 嚴重脊柱側后凸畸形后路全脊椎截骨術后殘留后凸畸形的原因及處理策略. 中華骨科雜志, 2008, 28(1): 14-19.
4.	劉臻, 邱勇, 史本龍, 等. 圍截骨區衛星棒技術在嚴重脊柱畸形三柱截骨術中的應用. 中華骨科雜志, 2015, 35(4): 349-356.
5.	Hyun SJ, Lenke LG, Kim YC, et al. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976), 2014, 39(22): 1899-1904.
6.	Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976), 2009, 34(20): E729-E734.
7.	Kim HJ, Lenke LG, Shaffrey CI, et al. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976), 2012, 37(22 Suppl): S144-S164.
8.	Liu H, Yang C, Zheng Z, et al. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2015, 40(8): 570-579.
9.	Takenaka S, Mukai Y, Hosono N, et al. Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J, 2014, 8(3): 322-330.
10.	Demirkiran G, Dede O, Karadeniz E, et al. Anterior and posterior vertebral column resection versus posterior-only technique: a comparison of clinical outcomes and complications in congenital kyphoscoliosis. Clin Spine Surg, 2017, 30(7): 285-290.
11.	李玉偉, 王海蛟, 崔巍, 等. 保留后方韌帶復合體的腰椎融合術遠期療效觀察. 中國修復重建外科雜志, 2019, 33(1): 56-60.
12.	Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
13.	王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
14.	Shi B, Zhao Q, Xu L, et al. SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study. Spine J, 2018, 18(11): 2059-2064.
15.	Liu FY, Zhao ZQ, Ren L, et al. Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports. Medicine (Baltimore), 2018, 97(52): e13846.
16.	Jo DJ, Kim YS, Kim SM, et al. Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Neurosurg Spine, 2015, 23(4): 510-517.
17.	Smith JS, Shaffrey CI, Ames CP, et al. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery, 2012, 71(4): 862-867.
18.	汪飛, 邱勇, 錢邦平, 等. 后路全脊椎截骨治療嚴重脊柱畸形內固定棒斷裂危險因素分析. 中華骨科雜志, 2012, 32(10): 946-950.
19.	Ataka H, Tanno T, Yamazaki M. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J, 2009, 18(1): 69-76.
20.	李超, 于海洋, 付青松, 等. 后柱切除后伸壓縮中柱矯治胸腰段骨質疏松性重度椎體壓縮骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(8): 700-705.

1. Saita K, Hoshino Y, Higashi T, et al. Posterior spinal shortening for paraparesis following vertebral collapse due to osteoporosis. Spinal Cord, 2008, 46(1): 16-20.
2. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2015, 74(1): 112-120.
3. 邱勇, 朱澤章, 王斌, 等. 嚴重脊柱側后凸畸形后路全脊椎截骨術后殘留后凸畸形的原因及處理策略. 中華骨科雜志, 2008, 28(1): 14-19.
4. 劉臻, 邱勇, 史本龍, 等. 圍截骨區衛星棒技術在嚴重脊柱畸形三柱截骨術中的應用. 中華骨科雜志, 2015, 35(4): 349-356.
5. Hyun SJ, Lenke LG, Kim YC, et al. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976), 2014, 39(22): 1899-1904.
6. Denis F, Sun EC, Winter RB. Incidence and risk factors for proximal and distal junctional kyphosis following surgical treatment for Scheuermann kyphosis: minimum five-year follow-up. Spine (Phila Pa 1976), 2009, 34(20): E729-E734.
7. Kim HJ, Lenke LG, Shaffrey CI, et al. Proximal junctional kyphosis as a distinct form of adjacent segment pathology after spinal deformity surgery: a systematic review. Spine (Phila Pa 1976), 2012, 37(22 Suppl): S144-S164.
8. Liu H, Yang C, Zheng Z, et al. Comparison of Smith-Petersen osteotomy and pedicle subtraction osteotomy for the correction of thoracolumbar kyphotic deformity in ankylosing spondylitis: a systematic review and meta-analysis. Spine (Phila Pa 1976), 2015, 40(8): 570-579.
9. Takenaka S, Mukai Y, Hosono N, et al. Major surgical treatment of osteoporotic vertebral fractures in the elderly: a comparison of anterior spinal fusion, anterior-posterior combined surgery and posterior closing wedge osteotomy. Asian Spine J, 2014, 8(3): 322-330.
10. Demirkiran G, Dede O, Karadeniz E, et al. Anterior and posterior vertebral column resection versus posterior-only technique: a comparison of clinical outcomes and complications in congenital kyphoscoliosis. Clin Spine Surg, 2017, 30(7): 285-290.
11. 李玉偉, 王海蛟, 崔巍, 等. 保留后方韌帶復合體的腰椎融合術遠期療效觀察. 中國修復重建外科雜志, 2019, 33(1): 56-60.
12. Bridwell KH, Lewis SJ, Rinella A, et al. Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg (Am), 2004, 86-A Suppl 1: 44-50.
13. 王翔宇, 譚倫, 林旭, 等. 光電導航引導單側穿刺椎體后凸成形術治療胸腰椎骨質疏松性椎體壓縮骨折. 中國修復重建外科雜志, 2018, 32(2): 203-209.
14. Shi B, Zhao Q, Xu L, et al. SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study. Spine J, 2018, 18(11): 2059-2064.
15. Liu FY, Zhao ZQ, Ren L, et al. Modified grade 4 osteotomy for kyphosis due to old osteoporotic vertebral compression fractures: Two case reports. Medicine (Baltimore), 2018, 97(52): e13846.
16. Jo DJ, Kim YS, Kim SM, et al. Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Neurosurg Spine, 2015, 23(4): 510-517.
17. Smith JS, Shaffrey CI, Ames CP, et al. Assessment of symptomatic rod fracture after posterior instrumented fusion for adult spinal deformity. Neurosurgery, 2012, 71(4): 862-867.
18. 汪飛, 邱勇, 錢邦平, 等. 后路全脊椎截骨治療嚴重脊柱畸形內固定棒斷裂危險因素分析. 中華骨科雜志, 2012, 32(10): 946-950.
19. Ataka H, Tanno T, Yamazaki M. Posterior instrumented fusion without neural decompression for incomplete neurological deficits following vertebral collapse in the osteoporotic thoracolumbar spine. Eur Spine J, 2009, 18(1): 69-76.
20. 李超, 于海洋, 付青松, 等. 后柱切除后伸壓縮中柱矯治胸腰段骨質疏松性重度椎體壓縮骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(8): 700-705.

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SRS-Schwab grade Ⅳ osteotomy combined with satellite rod for thoracolumbar old osteoporotic fracture with severe kyphosis

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