Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis

ABSTRACT

STUDY DESIGN: This study is a prospective, clinical study for lumbar degenerative kyphosis. PURPOSE: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis. OVERVIEW OF LITERATURE: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results. METHODS: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes). RESULTS: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 +/- 2.79 in group A and 26.44 +/- 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 +/- 3.3degrees in group A and 11.72 +/- 1.89degrees in group B. CONCLUSIONS: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.