Modified Pedicle Subtraction Osteotomy Research Articles

Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures: a retrospective study of 104 patients.

Osteoporotic vertebral compression fractures (OVCF) caused by osteoporosis is a common clinical fracture type. There are many surgical treatment options for OVCF, but there is a lack of comparison among different options. Therefore, we counted a total of 104 cases of OVCF operations with different surgical plans, followed up the patients, and compared the surgical outcome indications before, after and during the follow-up. 104 patients who underwent posterior osteotomy(Modified PSO, SPO, PSO, VCR) and kyphosis correction surgery at our hospital between April 2006 and August 2021 with a minimum follow-up period of 24 months were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high-energy trauma. The mean CT value was 71 HU, which was below 110 HU, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. Pre- and postoperative CL, TLK, TK, PrTK, TKmax, GK, LL, PI, SS, PT, SVA, TPA, were investigated radiologically. Additionally, We evaluated estimated blood loss, surgical time and perioperative symptom. The results show, after operation, TLK (37.32 ± 10.61° vs. 11.01 ± 8.06°, P < 0.001), TK (35.42 ± 17.64° vs. 25.62 ± 12.24°, P < 0.001), TKmax (49.71 ± 16.32° vs. 24.12 ± 13.34°, P < 0.001), SVA (44.91 ± 48.67 vs. 23.52 ± 30.21, P = 0.013), CL (20.23 ± 13.21° vs. 11.45 ± 9.85°, P = 0.024) and TPA (27.44 ± 12.76° vs. 13.91 ± 9.24°, P = 0.009) were improved significantly in modified Pedicle subtraction osteotomy (mPSO)after operation. During follow-up, TLK (37.32 ± 10.61° vs. 13.88 ± 10.02°, P < 0.001) and TKmax (49.71 ± 16.32° vs. 24.12 ±13.34°, P < 0.001) were improved significantly in Modified PSO group. In additon, estimated blood loss (790.0± 552.2ml vs. 987.0± 638.5ml, P = 0.038), time of operation (244.1± 63.0min vs. 292.4± 87.6min, P = 0.025) were favorable in Modified PSO group compared to control group. To conclude, mPSO could acquire a favorable degree of kyphosis correction as well as fewer follow-up complications. Compared with other surgical methods, it also has the advantages of less surgical trauma and shorter operation time. It can be an effective solution for the treatment of OVCF.

Simplified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Fractures.

In osteoporotic vertebral fractures (OVF) involving neurological symptoms and severe kyphosis, vertebral osteotomies are necessary but are associated with a high risk of complications. We performed a retrospective study. In 14 patients (mean age, 69.3 years old) with unstable thoracolumbar fractures associated with severe kyphosis, a posterior instrumentation with polymethylmethacrylate-augmented screws and a modified pedicle subtraction osteotomy (PSO) at the fracture level were performed to stabilize the spine and correct the kyphosis. The underlying principle behind the osteotomy's technique was to exaggerate the defect caused by the fracture and shorten the spine: (1) completion of a wide laminoforaminotomy, (2) use of successive reamers rotated in the pedicle at a 25° angle in the axial plane to obtain its complete decancellation, (3) insertion of the reamers in a more medial orientation (55°) to collapse the posterior wall, and (4) breakage of the lateral wall. Radiographic and clinical outcomes were analyzed pre- and postoperatively. Complications were reported. Functional scores improved after surgery. Oswestry disability index and visual analog scale scores decreased significantly (33 and 4 points, respectively). Patient satisfaction rate reached 93%. Average postoperative regional vertebral kyphosis was decreased to 3.79°. No dural tear or neurological injuries were observed. Blood loss of 920 mL (±350 mL) and two mechanical complications were reported. OVF can lead to severe deformities. In osteoporotic bones, the use of sequential reamers can simplify the PSO technique, allowing for the shortening and stabilization of the spine without manipulating the dural sac. The risk of neurological injuries and blood loss is decreased. 4.

Modified Pedicle Subtraction Osteotomy for Osteoporotic Vertebral Compression Fractures.

ObjectiveTo evaluate the cases of osteoporotic compression fracture with kyphotic deformity treated with modified pedicle subtraction osteotomy and analyze the usefulness of this osteotomy.MethodsTwenty patients (nine men, 11 women; mean age, 66.4 years; mean follow‐up duration, 39.6 months) who underwent modified pedicle subtraction osteotomy at our hospital between November 2003 and July 2012 with a minimum follow‐up period of 2 years were included. All cases were injuries induced by a fall incurred while standing or lifting heavy objects without high‐energy trauma. The mean bone mineral density‐dual energy x‐ray absorptiometry (BMD‐DEXA) was 0.673 g/cm2 (0.571–0.740 g/cm2), which was ‐2SD below normal, indicating severe osteoporosis. The indications for surgery included gait disturbance due to severe pain with pseudarthrosis, increased kyphotic angle, and progressive neurological symptoms. We evaluated Japanese Orthopaedic Association scores, Oswestry Disability Index scores, bone union, change in kyphotic angle, estimated blood loss, complications, and the patient's overall clinical satisfaction.ResultsThe collapsed vertebrae were thoracic (T9, 11, 12) in 13 cases and lumbar (L1) in seven cases. The mean pre‐ and post‐operative kyphotic angles were 26.2 ± 9.9 degrees and 8.3 ± 8.1 degrees, showing an 18.3‐degree correction. Plain radiography at the last follow‐up showed a mean angle of 17.9 ± 12.6 degrees, indicating a 9.5‐degree correction loss. The overall correction was 8.2 degrees. Bony union was achieved at the last follow‐up in all cases. Clinical outcomes showed improvement in mean Japanese Orthopaedic Association score from 13.2 to 21.7 and mean Oswestry Disability Index score from 40.3 to 13.6. Overall clinical patient satisfaction showed 12 excellent results, five moderate results, and three poor results. Mean operation time was 4.2 h (range, 4–6 h). The overall mean estimated blood loss (EBL) was 1098 mL (range, 750–1370 mL). The mean hospital stay was 3.6 weeks (range, 2–6 weeks). There was one case of cauda equina syndrome at 2 days postoperatively, and two cases of screw loosening. There were no cases of distal junctional kyphosis, but there were two cases of proximal junctional kyphosis.ConclusionsDespite limited correction of kyphotic angle, our modified pedicle subtraction osteotomy technique resulted in satisfactory outcomes in our patients, who had persistent severe back pain, increased kyphotic angle with pseudarthrosis, and progressive neurologic deficits. Nevertheless, this procedure requires careful follow‐up and strict surgical indications because of the risk of neurological damage and technical problems.

Modified C7 pedicle subtraction osteotomy for the correction of cervicothoracic kyphosis

BackgroundOsteotomies in the cervical spine are technically challenging. The purpose of this study was to evaluate the feasibility of the modified pedicle subtraction osteotomy (PSO) technique at C7 to be used for the treatment of cervicothoracic kyphosis secondary to ankylosing spondylitis.MethodsA total of 120 cervical spine computed tomography (CT) scans (of 82 male and 38 female patients) were evaluated. The scans were taken parallel to the middle sagittal plane and the sagittal plane intersecting the pedicles. Simulated osteotomy was performed by setting the apex of the wedge osteotomy at different points, and morphologic measurements were obtained. Seven patients with cervicothoracic kyphosis who underwent a modified PSO at C7 between May 2009 and June 2015 were retrospectively evaluated. The mean follow up was 32.9 months (range 21–54 months). Preoperative and postoperative chin-brow vertical angle (CBVA), sagittal vertical axis (SVA) and sagittal Cobb angle of the cervical region were reviewed. The outcomes were analyzed through various measures, which included the 36-Item Short Form Health Survey (SF-36) and a visual analog scale for neck pain.ResultsIn this morphometric study, a modified PSO was performed on 87 patients (59 male and 28 female) with a reasonable ratio of 72.5%. In the case series, radiographic parameters and health-related quality-of-life measures were found to show significant postoperative improvement in all patients. No major complications occurred, and no implant failures were noted until the latest follow up.ConclusionsThe modified PSO is a safe and valid alternative to the classic PSO, allowing for excellent correction of cervical kyphosis and improvement in health-related quality-of-life measures.

Clinical application of Tunnel-Plasty on modified pedicle subtraction osteotomy

Objective To summarize the technical points and clinical efficacy of pedicle subtraction osteotomy (PSO) in tunneling and to explore the related complications of this technique. Methods A total of 67 cases of old vertebral fractures of the thoracolumbar region from June 2012 to June 2017 were collected. According to the inclusion and exclusion criteria, a total of 41 cases were included in the study. There were 19 males and 22 females; aged 37-67 years, mean 60.1±12.7 years; 15 cases of non-surgical treatment after trauma, 13 cases of failure after surgery and 13 cases of osteoporosis. Injury segment: 9 cases of T11, 22 cases of T12, 8 cases of L1, 2 cases of LS. Preoperative patients were diagnosed by X-ray, CT plain and 3D reconstruction combined with MRI. There were 23 cases of intractable back pain, 16 cases of lower extremity root pain, and 2 cases of intermittent claudication. Patients were divided into the traditional PSO treatment group (21 cases) and modified PSO treatment group (20 persons) according to the random number method. The traditional group were treated with the egg shell technique, and the improved group were treated with tunnel forming technology. The procedure was divided into four steps: exposure (step 1), nail placement and resection of the posterior column complex (step 2), vertebral osteotomy (step 3), orthopedics and bone grafting (step 4). The operation time, bleeding volume and complications of each step were compared between the two groups. The clinical efficacy was evaluated using the visual analogue scale (VAS) score and the Oswestry disability index (ODI). The X-ray spine Cobb angle was measured to evaluate the Keloid deformity correction, and the bone graft fusion was observed by CT examination. Results All patients were followed up for 12 to 24 months. The total operation time of the traditional group was 273.3±21.1 min, and the total operation time of the modified group was 178.1±12.5 min, the difference between the two groups was statistically significant (t=8.981, P=0.0019). The differences between the two groups in steps 2 and 3 were statistically significant (t2=4.614, P2=0.036; t3=9.089, P3=0.020) . The difference in the total bleeding volume was statistically significant (t=8.529, P=0.011). The differences in the bleeding volume between the two groups in step 2 and step 3 were statistically significant (t2=11.933, P2=0.016; t3=6.972, P3=0.013). The Cobb angles of the traditional group before surgery, 1 week after surgery and half year after surgery were 40.2°±8.9°, 12.5°±6.8°, 10.4°±2.5°, respectively. The Cobb angles of the modified group before surgery, 1 week after operation and half year after surgery were 39.5°±6.3°, 10.4°±3.5°, 9.5°±1.9°, respectively. The differences in the Cobb angle between the preoperative, postoperative 1 week and postoperative half year were statistically significant(Fmodified group=189.573, Pmodified group=0.021; Ftraditional group=194.699, Ptraditional group=0.029). The bone fusion time in the osteotomy area was 3-6 months, with an average of 4.8 months. The VAC and ODI scores of half-year post operation of the traditional group were 2.1±0.3 and 34.1±4.3, and the improved group were 2.2±1.1 and 28.3±6.8, respectively, and the difference was not statistically significant. In the improved group, there were 1 case of over-excavation and 1 case of over-underexcavation (2/20), which were corrected in time during operation. In the traditional group, 4 cases (4/21) of dural tear occurred during the operation, and were repaired in time. Bone fusion was obtained half a year later. No clinical deaths, and no cases of surgical infection occured. Conclusion Tunnel forming technology is an alternative surgical procedure for treating old fractures of the thoracolumbar region with PSO, which can shorten the operation time, reducd intraoperative bleeding and reduce surgical complications. Key words: Osteotomy; Orthopedic procedures; Spinal fractures

Modified Pedicle Subtraction Osteotomy for Posttraumatic Kyphosis: Long Term Follow-Up

Background Data: Post traumatic kyphosis (PTK) of the thoracolumbar spine is a severe complication of spine fractures and its management can be quite challenging. Pedicle subtraction osteotomy includes posteriorly based wedge resection of the posterior column and both pedicles, with the hinge located at the anterior cortex of the vertebral body. It has been developed to achieve significant deformity correction. It does not involve the adjacent disc which is usually affected and represents a cause of pain, neurological compression and progression of deformity. Modified pedicle subtraction osteotomy (MPSO) including resection of posteriorly based wedge of posterior column and both pedicles together with the damaged disc to achieve correction and solid fusion between the affected vertebra and the adjacent one. It seems to be more suitable for the management of PTK.Purpose: The purpose of this prospective study is to review our experience with modified Pedicle subtraction osteotomy (MPSO) technique for the management of thoracolumbar posttraumatic kyphosis (PTK).Study Design: Prospective cohort clinical case study.Patients and Methods: From February 2010 to July 2014, 14 consecutive patients with PTK were managed by MPSO. The patients were followed clinically and radiologically. Back pain VAS, Denis work scale and regional kyphotic angle (RKA) were recorded and analyzed preoperatively, postoperative and at the latest follow up.Results: The study included 14 patients with an average age of 38.43±6.63 (26 - 48) years. The follow up period was 46.29±15.45 months. The average operative time was 286.43±12.74 minutes and per-operative blood loss was 1017.86±198.75 ml. Back pain VAS improved from 8.21±0.77 preoperatively to 2.50±0.73 at the last follow-up (P=0.034), and the Denis work scale improved from 4.43±0.49 preoperatively to 1.64±1.23 at the last follow-up (P=0.022). Neurological improvement occurred in one patient from ASIA grade D to E with no postoperative deterioration in any case. The regional kyphotic angle (RKA) significantly improved from 42.07±5.28° preoperatively to 2.67±2.58° after surgery (P=0.04) with a mean correction of 38.47±5.42°. The loss of correction was 1.92±0.73° at the latest follow-up. The complications included 2 dural tears and 3 postoperative wound infections.Conclusion: MPSO technique provides significant correction of patient’s kyphosis with a risk profile similar to a standard PSO procedure. (2016ESJ122)

Correction of posttraumatic thoracolumbar kyphosis with modified pedicle subtraction osteotomy

To evaluate the efficacy and safety of modified pedicle subtraction osteotomy for treatment of thoracolumbar old fracture with kyphosis. Methods: From January 2003 to January 2013, 58 patients of thoracolumbar kyphosis, who underwent modified pedicle subtraction osteotomy, were reviewed. Among them, 45 cases underwent initial operation and 13 cases underwent revision surgery. Preoperative and postoperative kyphotic Cobb's angle, score of back pain, as well as the incidence of complication were accessed by using visual analogue scale (VAS) and Oswestry disability index (ODI). Results: Mean follow-up duration was 42 months (range, 24-60 months). Average operative time was 258 min (range, 190-430 min), while average bleeding was 950 mL (range, 600-1 600 mL). All the patients were significantly improved in function and self-image, and achieved kyphosis correction with 17.9°± 4.3°. VAS of low back pain was decreased by 3.1±0.6; ODI was dropped by 25.3%±5.5%. 3 patients (5.2%) suffered anterior thigh numbness and got recovery after 3 months of follow-up. Complications happened in 19 patients, including 12 with cerebrospinal fluid leak, 4 with superficial wound infection, and 3 with urinary tract infection. All these complications were managed properly and none of them underwent reoperation. Conclusion: Modified pedicle subtraction osteotomy is a safe and effective technique for the treatment of old fracture with kyphosis.

Modified Pedicle Subtraction Osteotomy as a Salvage Method for Failed Short-Segment Pedicle Instrumentation in the Treatment of Thoracolumbar Fracture.

Retrospective study. Short-segment pedicle instrumentation (SSPI) is widely used to treat thoracolumbar junction fracture. Implant failure is the most common complication of SSPI and often necessitates revision surgery. The stand-alone anterior technique for failed SSPI provides excellent decompression and anterior column reconstruction, but it is incapable of restoring normal stability. High rate of complications is solely attributable to the anterior approach. Thus, the reconstruction of the anterior column with posterior compression instrumentation is the strategy of choice. In this study, we use a modified pedicle subtraction osteotomy (PSO) technique through a single posterior approach as the salvage method for the failed SSPI. Thirteen patients with failed SSPI after thoracolumbar fracture were included and followed up at regular intervals. Revision indications include intractable pain, deteriorating neurological deficits, and progressive deformity. The modified PSO was performed. After osteotomy, the anterior cortex was thinned and the anterior longitudinal ligament was also preserved to maintain stability during correction. Autograft was inserted into the osteotomy gap to increase stability and fusion rate. The correction had been achieved with closure. We evaluated the patients' clinical symptoms, segmental kyphosis correction, bony fusion time, and complications. Segmental kyphosis correction was from preoperative average 20.9 degrees (range, 9.5-38.5 degrees) to 3.0 degrees (range, 1-5.5 degrees) immediately after operation and 6.1 degrees (range, 3-8 degrees at the last follow-up). Bony fusion was confirmed on radiographs in all patients at an average of 9.9 months (range, 7.5-12 mo) after revision surgery. There was no implant failure in any of the 13 patients. Average preoperative visual analog scale was 6.5 (range, 5-9) and reduced to 3.7 (range, 2-5) at the last follow-up. There was also a significant decrease in mean preoperative Oswestry Disability Index from 55.2 (range, 38-76) to 32.8 (range, 16-56). No patients suffered any neurological deterioration related to revision surgery. Complications were encountered in 6 patients (46.1%), including 4 with cerebrospinal fluid leak and 2 with superficial wound infection. All these complications were managed conservatively and none of them underwent reoperation. We conclude that modified PSO possesses the advantages of excellent kyphosis correction, a safe and reliable salvage alternative for the revision of SSPI failure.

Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature.

The purpose of this study was to evaluate the clinical and radiographic outcomes of modified pedicle subtraction osteotomy (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients. From January 2008 to August 2012, 26 consecutive pediatric patients with thoracolumbar post-tubercular kyphosis underwent modified pedicle subtraction osteotomy (mPSO). The clinical and radiologic outcomes were analyzed preoperatively, postoperatively, and at the last follow-up. Twenty-six patients with thoracolumbar post-tubercular kyphosis underwent mPSO. The average operation time was 256 min (188~314 min). The mean follow-up was 41 months (18~56 months). The mean estimated blood loss was 870 ml (620 ~ 1020 ml). The thoracolumbar kyphotic angle ranged from 51° to 79° before operation, 60.6° in average. The mean thoracolumbar kyphotic Cobb angle was 19.7° after operation, with a mean correction of 40.9°. The C7 sagittal plumb line was 3.8 cm after operation, comparing to the 10.5 cm preoperative. The mean preoperative angle of thoracic kyphosis (TK) was 9.9° ± 1.2° and increased to 11.8° ± 1.4°, postoperatively. Lumbar lordosis (LL) improved from -22.8° ± 4.9° preoperative to -17.8° ± 2.1° postoperative. Visual analogue scale (VAS) was 8.7 ± 1.1 preoperative and 1.2 ± 0.4 postoperative, respectively. The mean Oswestry Disability Index (ODI) improved from 49.2 ± 5.3 before surgery to 10.8 ± 3.3 postoperative (P < 0.01). All patients received good bone healing, no significant loss of correction angle. Most patients (24/26) considered pain and exterior was significantly improved. Modified pedicle subtraction osteotomy (mPSO) is effective and reliable for thoracolumbar post-tubercular kyphosis in pediatric patients.

Surgical treatment of post-traumatic kyphosis using modified pedicle subtraction osteotomy

Background data Pedicle subtraction osteotomy (PSOS) is a pure closed wedge osteotomy that has been recently introduced for the correction of post-traumatic kyphosis (PTK). Modified PSOS uses the disc as part of the resected wedge together with the upper endplate, thus allowing excision of the degenerated disc material for better fusion and preventing failure. In PTK, the upper endplate is deficient and the upper disc is degenerated. Insertion of a spacer into the intervertebral gap ensures good bony contact and fusion and increases the angle of correction by making the correction in a manner of closed-open wedge rather than a pure closed wedge osteotomy. Purpose The aim of this work was to study the clinical and radiological results of surgical treatment of PTK using modified PSOS with insertion of a cage as a spacer into the intervertebral defect. Study design This was a prospective study conducted on 24 patients with symptomatic PTK. Patients and methods All patients were treated using the modified PSOS technique, with insertion of a cage into the intervertebral gap. Patients were assessed clinically and radiologically. Functional results were assessed using the Oswestry disability index (ODI) score and the Denis pain and work scale. Radiological assessment included local kyphosis angle and sagittal index immediately postoperatively and at the final follow-up, and the state of bony fusion and loss of correction at the last follow-up. Results The average follow-up period was 34.21 ± 4.47 (range 24-50 months). Local kyphosis angle improved from 39.08 ± 3.86° preoperatively to -0.25 ± 4.74° postoperatively, with insignificant change at the last follow-up. The sagittal index significantly improved from 41.33 ± 4.89° preoperatively to 1.81 ± 1.26° postoperatively, without significant change at the last follow-up. All patients showed solid bony fusion at the last follow-up. There were no major complications. All patients improved clinically as evidenced by improvement in pain and neurological status. Functional outcome significantly improved as evidenced by improvement in ODI score and return of most of the patients to their previous level of activity. Conclusion Modified PSOS is more anatomical, less technically demanding, and safe procedure that achieves good radiological and clinical outcomes with lower operative morbidity.

Corner osteotomy: a modified pedicle subtraction osteotomy for increased sagittal correction in the lumbar spine.

Sagittal imbalance is a spine deformity with multifactorial etiology, associated with severe low back pain and gait disturbance that worsen deeply patients' quality of life. The amount of correction achievable through PSO is limited by the height of the resection of the posterior wall, causing a ceiling of segmental correction of 30-35°. The aim of this study is to describe and preliminarily evaluate the results of an alternative technique, corner osteotomy (CO), that can increase the amount of correction. From March 2012, every patient examined in our Division, diagnosed with sagittal imbalance to be treated with PSO, underwent CO and fusion. This technique consists in removing the posterior vertebral arch, the pedicle and the posterior-superior corner of the vertebral body; the inferior endplate of the vertebra above is prepared and the superior adjacent disc removed to obtain, when closing the osteotomy, a direct interbody fusion. Ten patients undergoing CO were compared with 20 patients undergoing PSO regarding spinopelvic parameters, operative variables, complications and degree of correction. Patients undergoing CO obtained higher lordotic angle at the osteotomy than patients undergoing PSO (36.6°±8.2° vs 16.5°±9.5°, p<0.001) and had lower postoperative PT and SVA and higher average increase in lordosis. Complications were similar between groups. A trend toward longer surgical time, greater bleeding and higher transfusion rate was observed in the CO group, though this finding could be related to higher complexity of cases or incidence of associated anterior approach. Corner osteotomy technique was more effective than the PSO in increasing segmental and lumbar lordosis with modest increase in blood loss and similar complication rate. The CO technique, in addition, proved a good reproducibility. Further studies with larger populations should confirm these preliminary results.

Clinical and radiographic evaluation of posterior surgical correction for the treatment of moderate to severe post-tuberculosis kyphosis in 36 cases with a minimum 2-year follow-up

The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy. Each patient underwent single-stage correction via a posterior surgical approach. A modified pedicle subtraction osteotomy (mPSO) was performed when the kyphotic deformity was less than 70° (7 cases), whereas a posterior vertebral column resection (VCR) was performed when the kyphotic deformity exceeded 70° (29 cases). Full-length standing radiographs were obtained before surgery and at follow-up visits. These images were used to measure the kyphosis angle; sagittal alignment of the lumbar, thoracic, and cervical regions; and sagittal balance of the spine. Back pain was rated using the visual analog scale (VAS), and neurological function was classified based on the American Spinal Injury Association (ASIA) grading system. Each patient's overall satisfaction with surgical treatment was measured with the Patient Satisfaction Index. For purposes of comparison, patients were studied in 2 groups based on the region of their kyphotic apex. Half of the cohort had apical kyphosis in the lower thoracic spine or thoracolumbar junction (TL group). Using both radiographic and clinical assessments, the authors compared this group with the other half of the patients who had apical kyphosis in the upper to mid thoracic spine (MT group). The cohort included 15 males and 21 females, with an average age of 34 years at the time of surgery. The minimum follow-up was 24 months, and the mean follow-up was 31 months. Following surgery, kyphosis across the treated segments was reduced by an average of 60°. Lumbar lordosis also improved by an average of 24°, and thoracic kyphosis improved by an average of 20°. Both back pain and neurological function improved after surgical treatment. There was a 67% improvement in VAS scores, and 13 of the 36 patients had improvement in their ASIA grade. The 2 surgical procedures used for deformity correction (mPSO and VCR) demonstrated comparable radiographic and clinical results. Note, however, that differences were found in both radiographic and clinical outcomes in comparing patients who had lower thoracic or thoracolumbar (TL group) versus upper to midthoracic (MT group) apical kyphosis. Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.

Correction of posttraumatic kyphosis of the thoracolumbar spine with modified pedicle subtraction osteotomy

Correction of posttraumatic kyphosis of the thoracolumbar spine with modified pedicle subtraction osteotomy