The Comparative Study between Combined and Posterior Surgical Treatments for Post-traumatic Kyphosis / 대한정형외과학회잡지

PURPOSE: We wanted to analyse the differences of the radiological and clinical results between the combined approach and the posterior approach for treating posttraumatic kyphosis in elderly patients and to determine the risk factors for the loss of correction after the operation. MATERIALS AND METHODS: Between September 2004 and August 2009, 19 patients who underwent an operation for posttraumatic kyphosis and were follow-up for at least one year were included in this study. The combined approach (A group) was done for 10 patients, while the posterior approach (B group) was done for 9 patients. Radiological study and clinical evaluation, including the Korean version of the Oswestry disability index and the visual analog scale (VAS), were performed before surgery, after surgery and at the final follow-up. The risk factors related to the loss of correction of kyphosis at the fracture site were analyzed. RESULTS: In group A, the mean kyphotic angles were 35.2 before surgery, 11.1 degrees after surgery and 15.7 degrees at the final follow-up. There was 24.1 degrees (correction; 68.5%) of correction of the kyphotic angle with 4.6 degrees (19%) loss of correction. In group B, the mean kyphotic angles were 34.2 before surgery, 9.3 degrees after surgery and 13.8 degrees at the final follow-up. There was 24.9 degrees (72.8%) correction of the kyphotic angle with 4.5 degrees (18.3%) loss of correction. The clinical data was improved to the same degrees. The loss of correction was statistically correlated with osteoporosis. CONCLUSION: In conclusion, the posterior approach can correct the posttraumatic kyphosis in a fashion similar to that of the combined approach. The patient's osteoporosis should be thoroughly treated for preventing correction loss.

Posterior Surgery of Neurologically Compromised Osteoporotic Kyphosis: Posterolateral Decompression and Stabilization using Titanium Mesh / 대한정형외과학회잡지

PURPOSE: Several treatment options have been reported for post-traumatic kyphosis (PTK) and neurologically compromised osteoporotic fractures. However, there is no ideal surgical procedure. This study evaluated the effectiveness of posterolateral decompression and anterior support with a titanium mesh in PTK by posterior surgery. MATERIALS AND METHODS: Seventeen patients with PTK and neurologically compromised osteoporotic fractures underwent a single posterior approach. During posterior decompression, a titanium mesh was inserted through the posterior approach after a transpedicular intracorporeal corpectomy. Complications, operating time and blood loss were noted, and radiographic studies and neurological status were evaluated before surgery, after surgery, and at final follow-up. RESULTS: The mean kyphosis was 35+/-9.7degrees (range; 17-58degrees) before surgery, 3.2+/-1.8degrees after surgery (correction; 90.5%) and 5.5+/-3.2degrees at the final follow-up (correction; 85.5%). There was 29.6degrees correction of the kyphosis with a 6% loss of correction. Postoperative neurological improvement using the Frankel classification was demonstrated in all patients. There was no new onset or progressive neurological deterioration, additional surgery or extrusion of mesh. Three complications were encountered: one care each of pneumonia, prolonged ventilator support and distal adjacent vertebral fracture. CONCLUSION: The posterior insertion of a titanium mesh for anterior support appears to maintain the length of the anterior column, stabilize the injured vertebra and facilitate spinal fusion. Posterolateral decompression allows as direct a decompression as the anterior approach.

Surgical Treatment in Delayed Posttraumatic Thoracolumbar Kyphosis / 대한정형외과학회잡지

STUDY DESIGN: This is a retrospective study analyzing the clinical results of various surgical methods for the treatment of delayed posttraumatic kyphosis. OBJECTIVES: The purposes of this study are to define the risk factors of delayed postraumatic kyphosis and to establish a rational therapeutic guideline for the treatment of established kyphosis. METHODS: Sixteen cases of surgically treated delayed posttraumatic kyphosis were analyzed. Their initial injuries were burst type in 10, flexion-distraction in 5 and uncertain in l. Initial treatments were conservative in 10 and surgical in 6. Treatments for established kyphosis were posterior fusion in 2, anterior fusion in 5, combined anterior-posterior fusion in 9. Anterior decompression was carried out in 5 treated with anterior fusion and in 4 treated with combined anterior-posterior fusion. RESULTS: Mean follow-up was 2.7 years. The mean preoperative kyphosis of 28.6。 was reduced to 18.5。 (35.3% correction) with most pronounced correction in the group with combined anterior and posterior stabilization(44.8% correction). Early loss of correction averaged 2.7。 (18.5%) with least loss in the combined anterior-posterior group. Neurological improvement was related to the duration of the symptoms(P < 0.05). Back pain was improved in all patients. CONCLUSIONS: Thoracolumbar fractures with initial three column injuries or those rendered unstable by laminectomy are highly susceptible to development of delayed posttraumatic kyphosis; Combined anterior and posterior fusion offered the most satisfactory result in correction and stabilization of the deformity; Neurologic improvement was more pronounced with shorter duration of the symptoms.