Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

QIN Jie ¹ , SU Bao ¹ , WANG Linbang ¹ , TANG Ke ¹ , LIU Ruixue ² ,  QUAN Zhengxue ¹

1. Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;
2. Graduate School of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding?author：

Keywords：

Osteoporotic vertebral compression fracture; kyphosis deformity; transvertebral space and under the pedicle osteotomy

DOI：

10.7507/1002-1892.202110014

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the effectiveness of transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture (OVCF). Methods The clinical data of 11 patients with thoracolumbar kyphosis caused by old OVCF treated by transvertebral space and under the pedicle osteotomy between January 2016 and December 2020 were retrospectively analyzed. There were 2 males and 9 females, with an average age of 61.3 years (range, 50-77 years) and with a median disease duration of 8 years (range, 6 months to 50 years). Fracture reasons: 9 cases had a clear history of trauma, and 2 cases had no obvious incentive. A total of 11 vertebrae was involved in fracture, including T₁₂ in 3, L₁ in 7, L₂ in 1. The operation time, intraoperative blood loss, postoperative drainage volume, and complications were recorded. Full-length X-ray films of spine and local X-ray films of the operation area were examined before operation, at 7 days after operation, and at last follow-up. The Cobb angle of thoracolumbar kyphosis was measured, and the correction rate was calculated. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded to assess patients’ pain and functional improvement before operation, at 1 month after operation, and at last follow-up. Results All operations were successfully completed. The average operation time was 188.6 minutes (range, 140-215 minutes); the average intraoperative blood loss was 268.2 mL (range, 100-500 mL); the average postoperative drainage volume was 615.5 mL (range, 160-1 500 mL). One patient developed bilateral thigh rebound pain after operation, which relieved after symptomatic treatment of nutritional nerve and acesodyne. All patients were followed up 14.7 months on average (range, 6-56 months). At last follow-up, osseous fusion was observed in all patients, and no fracture, loose, or displacement of internal fixator was observed on imaging. At 7 days after operation and at last follow-up, the Cobb angle of thoracolumbar kyphosis significantly improved when compared with preoperative one (P<0.05), and there was no significant difference between at 7 days after operation and at last follow-up (P>0.05); the correction rates of Cobb angle at 7 days after operation and at last follow-up were 68.0%±9.8% and 60.3%±11.9%, respectively. At 1 month after operation and at last follow-up, the VAS score and ODI significantly improved when compared with preoperative ones, and further improved at last follow-up when compared with those at 1 month after operation, all showing significant differences (P<0.05). Conclusion Transvertebral space and under the pedicle osteotomy is an effective way to treat thoracolumbar kyphosis caused by old OVCF with less trauma, shorter operation time, and less intraoperative blood loss. Patients can obtain good orthopedic results and quality of life.

Citation： QIN Jie, SU Bao, WANG Linbang, TANG Ke, LIU Ruixue, QUAN Zhengxue. Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(3): 305-309. doi: 10.7507/1002-1892.202110014 Copy

1.	Munting E. Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects. Eur Spine J, 2010, 19 Suppl 1(Suppl 1): S69-73.
2.	李強, 李偉, 劉俊生, 等. 改良經椎弓根椎體截骨(PSO)治療陳舊性胸腰椎骨折伴脊柱后凸畸形. 浙江創傷外科, 2013, 18(6): 882-885.
3.	袁華澄, 林曉毅, 游戊己. 胸腰段陳舊性骨折伴后凸畸形經椎弓根截骨矯形策略. 脊柱外科雜志, 2010, 8(4): 230-232.
4.	Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med, 2007, 147(5): 330-338.
5.	卜保獻, 孫彥鵬, 呂振超, 等. 經椎間隙截骨矯形內固定治療胸腰椎陳舊性骨折并后凸畸形. 中醫正骨, 2012, 24(8): 41-42.
6.	Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int, 2005, 16 Suppl 2: S3-7.
7.	Scheyerer MJ, Simmen HP, Wanner GA, et al. Osteoporotic fractures of axial skeleton. Praxis (Bern 1994), 2012, 101(16): 1021-1030.
8.	陳仲強, 李危石, 郭昭慶, 等. 胸腰段陳舊骨折繼發后凸畸形的外科治療. 中華外科雜志, 2005, 43(4): 201-204.
9.	羅政. 后路椎間隙截骨矯形治療脊柱后凸畸形. 中國中醫骨傷科雜志, 2015, 23(12): 57-60.
10.	Xi YM, Pan M, Wang ZJ, et al. Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 1: S59-S66.
11.	徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2): 129-134.
12.	Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res, 1969, 66: 6-9.
13.	Diebo B, Liu S, Lafage V, et al. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S11-20.
14.	李波, 張銘華, 何盛江, 等. 經椎弓根椎體椎間隙截骨脊柱短縮術治療脊柱后凸畸形. 中國骨與關節損傷雜志, 2009, 24(3): 237-239.
15.	江龍, 王強, 吳寅良, 等. 經椎間隙脊柱Ⅳ級截骨治療陳舊性胸腰椎骨折伴后凸畸形的療效分析. 中國骨與關節損傷雜志, 2021, 36(3): 264-265.
16.	王春國, 胡文浩, 李靜, 等. 治療脊柱畸形常用后路截骨術術式研究進展. 脊柱外科雜志, 2018, 16(6): 368-374.
17.	Su Y, Ren D, Zou Y, et al. A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. Clinics (Sao Paulo), 2016, 71(6): 297-301.
18.	Liu D, Zhong D, Cao AH. Use of computed tomography compression ratio in diagnosis of disc injuries and posterior ligamentous complex injuries in osteoporotic thoracolumbar compression fractures. Iran J Radiol, 2021, 18(4): e111779. doi: 10.5812/iranjradiol.111779.

1. Munting E. Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects. Eur Spine J, 2010, 19 Suppl 1(Suppl 1): S69-73.
2. 李強, 李偉, 劉俊生, 等. 改良經椎弓根椎體截骨(PSO)治療陳舊性胸腰椎骨折伴脊柱后凸畸形. 浙江創傷外科, 2013, 18(6): 882-885.
3. 袁華澄, 林曉毅, 游戊己. 胸腰段陳舊性骨折伴后凸畸形經椎弓根截骨矯形策略. 脊柱外科雜志, 2010, 8(4): 230-232.
4. Kado DM, Prenovost K, Crandall C. Narrative review: hyperkyphosis in older persons. Ann Intern Med, 2007, 147(5): 330-338.
5. 卜保獻, 孫彥鵬, 呂振超, 等. 經椎間隙截骨矯形內固定治療胸腰椎陳舊性骨折并后凸畸形. 中醫正骨, 2012, 24(8): 41-42.
6. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int, 2005, 16 Suppl 2: S3-7.
7. Scheyerer MJ, Simmen HP, Wanner GA, et al. Osteoporotic fractures of axial skeleton. Praxis (Bern 1994), 2012, 101(16): 1021-1030.
8. 陳仲強, 李危石, 郭昭慶, 等. 胸腰段陳舊骨折繼發后凸畸形的外科治療. 中華外科雜志, 2005, 43(4): 201-204.
9. 羅政. 后路椎間隙截骨矯形治療脊柱后凸畸形. 中國中醫骨傷科雜志, 2015, 23(12): 57-60.
10. Xi YM, Pan M, Wang ZJ, et al. Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol, 2013, 23 Suppl 1: S59-S66.
11. 徐冠華, 崔志明, 李衛東, 等. 后路截骨矯形手術治療老年骨質疏松性陳舊胸腰椎骨折伴后凸畸形. 中國脊柱脊髓雜志, 2013, 23(2): 129-134.
12. Smith-Petersen MN, Larson CB, Aufranc OE. Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. Clin Orthop Relat Res, 1969, 66: 6-9.
13. Diebo B, Liu S, Lafage V, et al. Osteotomies in the treatment of spinal deformities: indications, classification, and surgical planning. Eur J Orthop Surg Traumatol, 2014, 24 Suppl 1: S11-20.
14. 李波, 張銘華, 何盛江, 等. 經椎弓根椎體椎間隙截骨脊柱短縮術治療脊柱后凸畸形. 中國骨與關節損傷雜志, 2009, 24(3): 237-239.
15. 江龍, 王強, 吳寅良, 等. 經椎間隙脊柱Ⅳ級截骨治療陳舊性胸腰椎骨折伴后凸畸形的療效分析. 中國骨與關節損傷雜志, 2021, 36(3): 264-265.
16. 王春國, 胡文浩, 李靜, 等. 治療脊柱畸形常用后路截骨術術式研究進展. 脊柱外科雜志, 2018, 16(6): 368-374.
17. Su Y, Ren D, Zou Y, et al. A retrospective study evaluating the correlation between the severity of intervertebral disc injury and the anteroposterior type of thoracolumbar vertebral fractures. Clinics (Sao Paulo), 2016, 71(6): 297-301.
18. Liu D, Zhong D, Cao AH. Use of computed tomography compression ratio in diagnosis of disc injuries and posterior ligamentous complex injuries in osteoporotic thoracolumbar compression fractures. Iran J Radiol, 2021, 18(4): e111779. doi: 10.5812/iranjradiol.111779.

Chinese Journal of Reparative and Reconstructive Surgery

Transvertebral space and under the pedicle osteotomy for thoracolumbar kyphosis caused by old osteoporotic vertebral compression fracture

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content