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Abstract
Objectives
A nalyzing the clinical outcome of operative treatment in lumbar degenerative kyphosis (LDK) by means of anterior and posterior operation using Wedged cage (SynCageⓇ) and pedicle screws.
Summary of Literature Review
LDK is common in old farmers who have worked in a stooping posture for decades and is a quite rigid form of kyphosis accompanied by adjacent instability, dystrophic changes of vertebral bodies and weakness of back and hip extensors. For surgical treatment, restoration and maintenance of lumbar lordosis is mandatory for global balance. A nterior release and restoration of disc space with the same morphologic cage seems to be a quite anatomic and harmonious approach.
Materials and Methods
Ten LDK patients, who underwent anterior interbody fusion using Wedged cage (SynCageⓇ) and posterior fusion with pedicle screws between 2000 to 2001, were followed up for more than 2 years. The operation was done in one or two stages. We performed anterior release, gradual widening of the intervertebral space with wedge trials of increasing size, insertion of wedged cages filled with auto-, allo- or synthetic bone and posterior pedicle fixation and fusion. We measured the lumbar lordotic angle, sacral inclination, fusion segmental angle, thoracic kyphotic angle and vertical axis line in preoperative, immediate postoperative and follow- up standing X - ray.
Results
Mean fusion segments using Wedged cage were 2.8 segments for anterior interbody fusion and 3.4 segments for posterior fusion. Mean sagittal correction angle was 40.3° with mean correction loss of 2.6°. Whole lordosis was 6.9° kyphosis pre-operatively, which was corrected to 33.4° lordosis postoperatively and 30.8° lordosis at last follow- up. Mean sacral inclination was corrected from 18.2° preoperatively to 37.8° postoperatively and 30.7° at follow- up. Vertical axis line was corrected from 11.4 cm preoperatively to 0.4 cm postoperatively and 1.3cm at follow- up. Thoracic lordosis was corrected spontaneously without any surgical extension to the thoracic spine by mean 19.9° (0.2° lordosis preoperatively to 19.7 ° kyphosis at follow- up). Loss of cardinal signs occurred in 70- 80 % of patients and satisfactory clinical results were shown in 90% of patients.
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Fig. 1.
(A) Standing lateral radiograph of a 60 year-old female with lumbar degenerative kyphosis was showed kyphosis 7 degree of lumbar lordosis angle. (B) Immediate postoperative standing lateral radiograph was showed 48 degree lodorsis of lumbar lordosis angle. Lumbar lordosis correction was 55 degree. (C) Postoperative 24 month radiograph was showed 43 degree lordosis of lumbar lordosis angle. Correction loss was 5 degree.
Fig. 2.
(A) Standing lateral radiograph of a 63 year-old female with lumbar degenerative kyphosis was showed lordosis 9 degree of thoracic angle. (B) Immediate postoperative standing lateral radiograph was showed posterior tilt of upper end vertebra. (C) Postoperative 25 month radiograph show 18 degree kyphosis of thoracic angle. Thoracic angle correction was 27 degree.
Table 1.
Results of ten operated cases of LDK
| Case | Age | eSex | Associated disease | Method | Pre OP | IPO | F/U | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| L LA∗ | FSA† | SI∮ | C7-S1 | TKA‡ | LLA | FSA | C7-S1 | LLA | FS A | SI | C7-S1 | T KA | |||||
| 1 | 63 | F | PR§:L3-L5 Ant: L3-L5 Pos t:L3-S 1 | -2 2 | -22 | -1 0 | 8.8 | 9 | 25 | 29 23 | 0.5 | 2 6 | 30 | 22 | 3 | -18 | |
| 2 | 55 | F | Spinal stenosis | Ant:L3-L5 Post:L3-L5 | -13 | -9 | 2 5 | 15. 5 | 13 | 28 | 22 39 | 5.5 | 14 | 21 | 34 | 1 .5 | -2 |
| 3 | 71 | M | Spinal stenosis Spondylolisthesis | Ant:L3-S1 Pos t :L3-S1 | 25 | 25 | 32 | - 1.5 | -38 | 32 | 32 41 | -5.2 | 38 | 33 | 30 | -4.9 | -38 |
| 4 | 60 | F | Spondyl olisthesis | P R :L4-S1 Ant : L3-S1 Pos t:L3-S 1 | -7 | -30 | 7 | 24 | 39 | 48 | 3 4 46 | 1.3 | 43 | 24 | 36 | 9 | -8 |
| 5 | 58 | F | Instability Spo ndylolysis | Ant : L3-S1 Pos t:L3-S 1 | - 15 | -15 | 17 | 13. 4 | -9 | 29 | 2 5 43 | 6.4 | 21 | 22 | 24 | 4 | -13 |
| 6 | 57 | M | Ant:L3-S1 Post:L2-S1 | 0 | -6 | 16 | 8 | 3 | 33 | 3 4 37 | 1 | 30 | 32 | 31 | 1 | -21 | |
| 7 | 58 | F | Spinal stenosis | Ant:T12-L3 Post:T12-L3 | 25 | - 31 | 3 9 | 11 | -3 | 56 | 0 60 | -1 | 52 | - 2 | 46 | -2 .9 | -24 |
| 8 | 70 | M | Old comp. fx L3 | An t :L3-S1 Post : T12 -S1 | -34 | -32 | 14 | 19 .1 | -12 | 31 | 2 7 24 | -6.1 | 3 0 | 27 | 28 | -4.5 | -31 |
| 9 | 67 | F | Spinal stenosis | An t :L3-S1 Post : L3-S1 | 4 | -3 | 27 | 3.1 | 1 | 26 | 2 7 27 | 2.7 | 27 | 26 | 35 | 2.5 | -20 |
| 10 | 68 | F | Ant : L2-S1 Po st: L2-S1 | -32 | -25 | 15 | 13 | -1 | 26 | 3 1 38 | -1.4 | 2 7 | 28 | 21 | 4.4 | -22 | |
| Ave rage | 62.7 | Ant: 2.9 Post: 3.4 | -6.9 | -14.8 | 18.2 | 11. 4 | 0.2 | 33.4 | 26.1 37.8 | 0.4 | 30.8 | 24.1 | 3 0.7 | 1 .3 | -19.7 |
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