Surgical treatment of old thoracolumbar fracture with kyphotic deformity through posterior pedicle subtraction osteotomy

ZHENG Jia-zhuang; ZHANG Zhi; CHEN Yu; WANG Fan-dong; CAI Qi-lin; LIU Yuan-bin

doi:10.3969/j.issn.1009-4237.2017.07.005

Abstract：Objective To evaluate the therapeutic effect of posterior pedicle subtraction osteotomy in treating old thoracolumbar segment fracture (6.5(0.5-12)years on average) with kyphotic deformity.Methods Thirty-one cases of single old thoracolumbar fracture with kyphotic deformity were treated in Suining Central Hospital from Mar.2009 to Jun 2013 ,including 23 males and 8 females,with age from 28 years to 62 years (average,41.5 years).The fracture was at T11 in 4 cases,at T12 in 9,at L1 in 11,and at L2 in 7.The preoperative Cobb degree was 32.5°±7.5°,and the VAS (visual analog scale,VAS) was 7.6±2.1. According to ASIA neurological function classification,the preoperative neurological function was grade C in 9 cases,grade D in 18 cases and grade E in 4 cases. All cases were treated with pedicle subtraction osteotomy,pedicle fixation and posterior-lateral bone graft.Results No complication occurred,such as wound infection,leakage of cerebrospinal fluid or nerve injury.The postoperative Cobb degree was 7.4°±2.5°,which had significant differences when compared with before operation.Twenty-seven cases were followed up for 30-73 months ,with an average of 48.5 months.At the latest followed-up time,the Cobb degree was 8.2°±3.1°,the VAS score was 2.3±0.9,and the neurological function of all cases was Grade E.Conclusion Surgical treatment of old thoracolumbar segment fracture with kyphotic deformity through posterior pedicle subtraction osteotomy can regain and maintain the physiological curvature of vertebral column,and also improve the functional recovery of nerve,which is a safe and effective method for treatment of old thoracolumbar fracture with kyphotic deformity.