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Abstract
Summary of literature Review
There were many proposed surgical treatments for lumbar degenerative kyphosis but the best treatment is still controversial.
Materials and Methods
Thirty three patients (all female) had undergone surgery. The mean age at surgery was 61.2. The average follow-up period was 34.7 months. The patients were divided into three groups. Group A included 7 cases with a correction by a posterior osteotomy, Group B included 15 with a posterior correction without an osteotomy, and Group C included 11 with combined anterior-posterior surgery. The radiographic measurements of lumbar lordosis, upper lumbar lordosis, lower lumbar lordosis, and pelvic tilt were performed before surgery, after surgery, and at the final follow-up visit. The loss of correction, complication rates and the clinical results were also compared.
Results
Postoperative correction of the lumbar and lower lumbar lordosis were significantly higher in group A and C than group B. The correction of upper lumbar lordosis was significantly higher in group A than group C. On the final follow-up, there was no significant difference in the loss of correction and clinical results between the three groups. The number of cases with complications in groups A, B and C was 4 (57%), 2 (13.3%) and 2 (18.2%), respectively. Two patients in group A required additional surgery.
Conclusions
Groups A and C were more effective than posterior-only correction. There was no significant difference in the clinical results between the three groups but complication rate was higher in Group A than the other groups. Combined anterior and posterior surgery can be a safe and effective method for correction.
REFERENCES
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Fig. 1.
Radiographs of three operative groups (A) Posterior osteotomy, (B) Posterior surgery only, (C) Combined anterior and posterior surgery
Fig. 2.
Radiographic measurements (A) Lumbar lordosis angle, (B) Upper lumbar lordosis angle, (C) Lower lumbar lordosis angle, (D) Pelvic tilt angle (PT), pelvic incidence (PI), sacral slope (SS)
Fig. 3.
Changes of radiographic parameters (A) Lumbar lordosis angle, (B) Upper lumbar lordosis angle, (C) Lower lumbar lordosis angle, (D) Pelvic tilt angle. ∗p<0.05 by Kruskal-Wallis test
Table 1.
Patients demographics and clinical data
Table 2.
Age and fused segments number of three operative methods
| Group A | Group B | Group C | Total | P value | |
|---|---|---|---|---|---|
| Number of cases | 7 | 15 | 11 | 33 | |
| Age (Yr) | 58.1 | 63.9 | 60 | 61.2 | 0.118 |
| F/U periods (Mo) | 53.9 | 34.2 | 34.7 | 39.2 | 0.097 |
| Fused segments | 5.4 | 4.9 | 4.7 | 4.9 | 0.825 |
Table 3.
Summary of radiographic measurements
Table 4.
Comparison of radiographic parameters according to clinical outcome
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