Multilevel non-contiguous thoracic pedicle subtraction osteotomy for fixed rounded hyperkyphotic deformity of the thoraco-lumbar junction with anterior bony fusion: technical note

Journal of Orthopaedics and Traumatology

Original Article

Giuseppe Geraci¹  Cesare Faldini¹  Marco Manzetti¹  Francesca Barile¹  Giovanni Viroli¹  Alberto Ruffilli¹ 

[1] Department of Biomedical and Neuromotor Science—DIBINEM, University of Bologna, 1St Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;

关键词: Kyphosis;    Thoracolumbar junction;    Pedicle substraction osteotomy;    Sagittal imbalance;   

DOI  :  10.1186/s10195-022-00665-4

 received in 2022-04-17, accepted in 2022-08-29,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundFixed severe hyperkyphotic deformities spread over more than five vertebral levels represent a therapeutic challenge, especially when the deformity apex is located at the thoraco-lumbar junction, thus requiring a huge amount of correction. The aim of this article is to describe an innovative all-posterior corrective technique based on multilevel non-contiguous thoracic pedicle subtraction ostoeotomy (PSO).Materials and methodsA retrospective review of three patients with fixed severe thoracic hyperkyphosis (a deformity angle of over 70°) with a thoraco-lumbar apex (between T11 and L1) treated by simultaneous two-level thoracic PSO and thoraco-lumbar posterior fusion was performed. Radiographic and clinical records were evaluated pre-operatively, post-operatively and at last follow-up (after a minimum of 2 years). Each variable was presented as mean ± SD (standard deviation). Statistical analyses were performed using paired t-tests (P value < 0.05 was considered significant).ResultsThe mean local deformity angle decreased by 75% (from 81.3° ± 2.1° to 20.7° ± 1.4°, p < 0.001), the post-operative thoracic kyphosis decreased by 46% (from 61.4° ± 2.4° to 33.2° ± 0.9°, p < 0.001) and the sagittal vertical axis decreased by 73% (from 14.7 cm ± 0.8 cm to 3.9 cm ± 0.3 cm, p < 0.001). No differences were observed in the radiological results between post-operative values and those at the final follow-up. The average Oswestry Disability Index (ODI) score reduced from 65.7 ± 1.8 pre-operatively to 17.3 ± 1.7 at last follow-up (p < 0.001). No neurological, mechanical nor infective complication occurred.ConclusionsThe presented technique, although technically demanding, proved to be a safe and effective alternative for the management of fixed severe thoraco-lumbar junction hyperkyphotic deformities.Level of evidence: IVTRIAL REGISTRATION Retrospectively registered

【 授权许可】

CC BY   
© The Author(s) 2022. corrected publication 2022

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