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Kang, Jeon, Jeon, Choi, and Roh: Undercorrection of the Thoracolumbar Kyphotic Deformity in the Osteoporotic Spine Fractures
Original Article

Journal of Korean Spine Surg 2005;12(1):63-68.

Published online: 21 February 2005

DOI: https://doi.org/10.4184/jkss.2005.12.1.63

Undercorrection of the Thoracolumbar Kyphotic Deformity in the Osteoporotic Spine Fractures

Yong Ho Kang, M.D., Ho Seung Jeon, M.D., Seung Ju Jeon, M.D., Je Ho Choi, M.D., Seung Kyu Roh, M.D.

Department of the Orthopaedic Surgery, Sung Ae Hospital, Seoul, Korea

Address reprint requests to Yong Ho Kang, M.D. Department of the Orthopaedic Surgery, Sung Ae Hospital, Shingil Dong 451-5, Youngdeungpo-Gu, Seoul, Korea Tel: 82-2-840-7236, Fax: 82-2-840-7237, E-mail: kyh1604@unitel.co.kr

Copyright © 2005 Korean Society of Spine Surgery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

A retrospective study.

Objectives

To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity.

Summary of Literature Review

The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone- screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity.

Materials and Methods

We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average followup period of 15.2 months. A ccording to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the pre-operative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KA C). The clinical results were evaluated at the last followup.

Results

The kyphotic angles at the preoperative, postoperative and last followup were 33.5°± 9.3, 22.4°± 6.9 and 24.7°± 6.8, respectively. We obtained a mean KA C gain of 11.1° postoperatively (p<0.05), but a loss of 2.3° at the last followup (p>0.05).
The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases.

Conclusions

Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.

Keywords: Thoracolumbar spine, Fracture, Osteoporosis, Kyphosis, Undercorrection

REFERENCES

1). Park BC, Lee SM. Correction of thoracolumbar kyhotic deformity using a posterior interbody fusion. J Kor Spine Surg. 2000; 7:639–646.
2). Cho KN, Yoon HK, Jeon HS, Jeon SJ, Kim WS. Efficiency of posterior lumbar interbody fusion in lumbar spinal stenosis with osteoporosis. J Kor Spine Surg. 1999; 6:380–387.
3). Soshi S, Shiba R, Kondo H, Murota K. An experimental study on transpedicular screw fixation in relation to osteoporosis of the lumbar spine. Spine. 1991; 16:1335–1341.
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Figures and Tables%

Fig. 1.
65-year-old female with osteoporotic compression fracture at T11/T12/L1/L2 associated with posttraumatic kyphoscoliosis. Preoperative AP and lateral radiographs show Jikei grade III/III osteoporosis with 35° of T10 to L2 kyphosis. Fig. 1. 3 years ago, vertebroplasty performed for compression fracture T11/T12 (A). Postoperative radiographs after kyphosis correction T10 to L2, percutaneous vertebroplasty for L1/L2 and PMMA augmentation for Rt T10, L3, L4 and L5 show correcrion of T10 to L2 kyphotic angle to 30° (B). The 16 months followup radiograph shows no loss of correction and no device-related problems (C).
jkss-12-63f1.tif
Table 1.
Analysis of Case
Case Age/ Gender Dx Fusion level VP PMMA Augmentation
1 71/F Kümmell's disease T11/L1 T11 to L2 T9/T11/T12/ None
Com. Fx. T9/L1/L2 L1/L2
Posttraumatic kyphosis
2 65/F Com. Fx. T11/T12/L1/L2 T10 to L2 L1/L2 T10/L3/L4/L5 (Rt)
Posttraumatic kyphoscoliosis
3 74/M Kümmell's disease T12 T11 to L2 T11(Rt)/ None
Posttraumatic kyphosis L1(both)
4 63/M Kümmell's disease T12 T11 to L2 L2(both) T11(Rt)
Com. Fx. L2
Posttraumatic kyphosis
5 68/F Kümmell's disease T11 T10 to L2 None None
Old Com. Fx. L1
Posttraumatic kyphoscoliosis
6 70/F Kümmell's disease T11/L1 T10 to L2 T9/T12 T11(Rt)
Com. Fx. T9/T12
7 70/F Kümmell's disease T11 T10 to L1 T12(Rt) L1(Lt)
Posttraumatic kyphosis
8 79/F Com. Fx. T12/L1 to L3 T11 to L2 T12/L1/L2 None
Posttraumatic kyphoscoliosis
9 80/F Kümmell's disease T12 T11 to L3 None T12/L1(Rt)
Posttraumatic kyphosis
10 69/M Kümmell's disease T11 T10 to L2 None None
Old Com. Fx. L1
Posttraumatic kyphosis
11 69/F Kümmell's disease T12 T11 to L3 None T12/L1(Lt)
Posttraumatic kyphosis
12 82/F Kümmell's disease T11 T10 to L2 T12 None
Old Com. Fx. L2
13 80/F Kümmell's disease T12 T11 to L3 L2 L4(Lt)
Posttraumatic kyphosis
14 69/F Com. Fx. T12/L1/L2 T11 to L3 T12/L1/L2 None
Posttraumatic kyphoscoliosis

Dx: Diagnosis VP: Vertebroplasty PMMA: Polymethylmethacrylate Rt: Right Lt: Left Com. Fx: Compression Fracture F: Female M: Male

Table 2.
Kyphotic Angle Correction
Pre- Op Post-Op Last F/U
Mean KA 33.5° 22.4° 24.7°
KAC* Gain (11.1°) (-2.3°)

KA : kyphotic angle

KAC* : kyphotic angle correction

Table 3.
Postoperative Complication(N=14)
Perioperative During F/U
Upper GI bleeding 1
Compression fracture 1
below fused segment
Screw pullout none none
Total 1 (7.1%) 1 (7.1%)
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