Choice of osteotomy methods for old thoracolumbar osteoporotic fracture with kyphosis

Abstract

To investigate the clinical outcome of single or double-segment pedicle subtraction osteotomy (PSO) for the treatment of old thoracolumbar osteoporotic compression fractures with kyphosis. The clinical data of 26 patients with old thoracolumbar osteoporotic compression fractures with kyphosis who underwent surgery from January 2015 to June 2017 were retrospectively analyzed. There were 12 males and 14 females, aged from 58 to 72 years old with an average of 65.6 years. The time interval from fracture to surgery was (8.2±1.5) years. According to different surgical methods, the patients were divided into single-segment PSO group (group A) and double-segment PSO group(groupB). The perioperative data, preoperative and postoperative imaging data and postoperative complications were recorded, and the Oswestry Disability Index (ODI) and visual analogue scale (VAS) were used before and after surgery to evaluate the clinical effect. All patients were followed up for 6-24 months with an average of 14.5 months. There was a statistically significant difference in operation time and intraoperative blood loss between the two groups (P<0.05). There was no significant difference in total drainage volume and length of hospital stay (P>0.05). The postoperative correction angle of the single segment PSO group was (33.3± 9.4) ° with the correction rate of 85.3% and the double segment PSO group was (41.0±13.5) ° with the correction rate of 92.7%, and there was statistical significance between two groups (P<0.05). There were no significant differences in postoperative lumbar lordosis (LL), sagittal vertical axis (SVA), and ODI, VAS between two groups (P>0.05). One case of cone injury occurred in the single-segment PSO group and recovered after treatment. There were no complications of spinal cord injury in the double segment group. Loose screws occurred during surgery in three patients in the single-segment PSO group and one patient in the double-segment PSO group (P<0.05). All 4 patients were re inserted with screws after using bone cement to reinforce the nail pathway. There were no complications such as anterior spinal vascular and nerve damage or osteotomy unfusion. Both single-segment PSO and double-segment PSO can achieve good orthopedic and clinical effects in the treatment of old thoracolumbar osteoporotic fractures with kyphosis. For patients with correction angles greater than 40° , the double-segment PSO provides a better correction angle and is safer, but it is with longer operation time and more intraoperative bleeding.