Pedicle Subtraction Wedge Osteotomy in Kyphosis after Osteoporotic Compression fracture
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概要
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Objective: A retrospective study was done on a series of patients in whom authors performed a pedicle subtraction wedge osteotomy within a single vertebral body for deformity correction and decompression. Methods: The authors performed 16 pedicle subtraction osteotomy procedures in patients with thoracolumbar kyphosis after osteoporotic vertebral fracture (OVF). Fourteen cases were available for follow-up 24 months after operation, averaging 33 months (range 27-51 months), are included. Patient examination and interviews, subjective questionnaire, chart reviews, and radiographic measurements were performed. All patients had severe pain and/or deformity; 12 (86%) cases had a preoperative neurologic deficit including two patients with cauda equina syndrome. 6(42%) patients were unable to stand. Their mean age was 66.1 years (range 52-76 years). The mean local kyphotic deformity before surgery was -34.1 degrees (range -58 to -19 degrees). Results: At 24-month follow-up, the mean local kyphotic deformity measured -10.7 degrees (range - 24 to 12 degrees), indicating that the mean surgical correction was 23.5 degrees (range 10 to 36 degrees); All the 12 preoperative neurologic deficit cases improved postoperatively. All patients reported decreased back pain at follow up without narcotic analgesic medication. Complications included two temporary minor neurological injuries and three associated medical complications. There was one case of a neural compression by the dural wrinkling treated conservatively. There were no deaths and prolonged intensive care stay. Conclusion: Pedicle subtraction osteotomy provides both sagittal correction of kyphotic deformity and decompression of spinal cord in the thoracolumbar region. Complications, risks were affordable if patients were carefully selected.
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