Apical Lordosating Osteotomy and Minimal Segment Fixation for the Treatment of Thoracic or Thoracolumbar Osteoporotic Kyphosis

Purpose: Current surgical options for osteoporotic kyphosis involve a risk of complex surgery in elderly patients, graft problems (e.g., graft dislodgement, subsidence, and pseudoarthrosis), and instrumentation problems (e.g., adjacent-segment failure, and implant pullout). This study is to assess the effectiveness of apical lordosating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis. Methods: Thirty-two consecutive patients (average age, 71.1 years; range, 65-81 years) with thoracic or thoracolumbar osteoporotic kyphosis underwent ALO. Mean follow-up was 3.2 years (range, 2.1-6.1 years). Radiographic studies, complications, and patient satisfaction were assessed. Results: Mean operative time was 135 min, and mean blood loss was 722 mL. In 11 patients with thoracic hyperkyphosis, the mean Cobb angle was corrected from 81.6° (range, 73°-97°) to 24.3° (range, 18°-30°), indicating normal kyphosis. In 19 patients, thoracolumbar kyphosis of 54.4° (range, 45°-71°) was corrected to -2.3° (range, -11° to 8°). Sagittal imbalance was 11.5 cm before surgery and 4.8 cm after. Satisfactory correction was achieved in all patients, without anterior release. Local kyphosis was corrected to -9.3° from 51.2°, and mean vertebral kyphosis, to -25.3° from 15.6°. In 17 patients with neurologic deficit, Frankel grades improved postoperatively. No major complication occurred. All patients reported improved pain levels, self-image, and overall satisfaction. Conclusions: ALO and minimal segments fixation is effective for managing thoracic or thoracolumbar osteoporotic kyphosis. It obviated anterior procedures and had fewer complications and high patient satisfaction.

並列關鍵字

apical lordosating osteotomy ； graft problems ； instrumentation problems ； minimal segment fixation ； osteoporotic kyphosis

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