Analysis of effects of asymmetrical pedicle subtraction osteotomy for degenerative lumbar kyphoscoliosis with concomitant trunk imbalance

ZHU Feng; QIU Yong; QIAO Jun; BAO Hong-da; ZHU Ze-zhang; XU Lei-lei; WANG Bin; QIAN Bang-ping; YU Yang

doi:10.3969/j.issn.2095-252X.2013.10.003

Abstract：Objective To investigate the orthopedic effects of asymmetrical pedicle subtraction osteotomy ( APSO ) in the treatment of degenerative lumbar kyphoscoliosis with concomitant trunk imbalance. Methods From February 2008 to May 2012, 11 middle-aged and elderly patients with degenerative lumbar kyphoscoliosis were adopted and underwent surgical treatment in our hospital. There were 4 males and 7 females, whose mean age was 64.8 years old ( range;52-76 years ). They were followed up for more than 1 year. All patients underwent posterior APSO, pedicle screwinternal fixation and bone graft fusion. Radiographic parameters including the coronal and sagittal spinal deformity and trunk balance were measured to evaluate the orthopedic effects based on the whole-spine anteroposterior and lateral X-ray iflms in the erect position preoperatively and postoperatively. The Scoliosis Research Society-22 ( SRS-22 ) Questionnaire and the Visual Analogue Scale ( VAS ) were used to evaluate outcomes. Results Operations were safely performed on all the patients. The average operation time was 4.1 hours ( range;3.2-6.5 hours ), while the average blood loss during the surgery was 1280 ml ( range;780-3400 ml ). The coronal Cobb’s angle was improved from 43.1° preoperatively to 24.1° postoperatively, and the correction rate was 44.1%. The central sacral vertical line ( CSVL ) was improved from 3.8 cm to 1.1 cm. The mean sagittal kyphosis was improved from 43.2° to 15.4°, and the correction rate was 64.4%. The sagittal vertical axis ( SVA ) was improved from 6.2 cm to 1.2 cm. All the parameters stated above were signiifcantly improved postoperatively when compared with those preoperatively. In addition, the SRS-22 total scores and scores in each dimension were signiifcantly improved ( 68.1±8.9 point vs. 61.3±7.5 points, P<0.01 ), and the VAS score was decreased from ( 6.6±1.8 ) points to ( 2.1±1.5 ) points ( P<0.01 ). No complications such as severe neurovascular injury or infection occurred postoperatively. Conclusions APSO <br> caneffectively restore the coronal balance and sagittal balance of the trunkat the same time, improve the life quality and relieve pain for the patients with degenerative lumbar kyphoscoliosis. This surgical procedure is safe and effective.