Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis.

STUDY DESIGN

Retrospective review.

OBJECTIVE

To assess the effectiveness of apical lordosating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis (OK).

SUMMARY OF BACKGROUND DATA

Current surgical options for OK involve a risk of complex surgery in elderly patients, graft problems (e.g., graft dislodgement, subsidence, pseudarthrosis), and instrumentation problems (e.g., adjacent-segment failure, implant pullout). A posterior-only approach was used to make the surgery less invasive and safer.

METHODS

A total of 26 consecutive patients (average age 71.5 years, range 65-81) with thoracic or thoracolumbar OK underwent ALO. Mean follow-up was 3.2 years (range 2.1-6.1). Radiographic studies, complications, and patient satisfaction were assessed.

RESULTS

Mean operating time was 137 minutes, and mean blood loss was 717 mL. In 8 patients with thoracic hyperkyphosis, mean Cobb angle was corrected from 82.7 degrees (range 75 degrees-97 degrees) to 25.8 degrees (range 18 degrees-30 degrees), indicating normal kyphosis. In 18 patients, thoracolumbar kyphosis of 56.3 degrees (range 47 degrees-71 degrees) was corrected to -1.8 degrees (range -11 degrees to 7 degrees). Sagittal imbalance was 12.1 cm before surgery and 4.9 cm afterward. Satisfactory correction was achieved in all patients, without anterior release. Local kyphosis was corrected to -9.1 degrees from 53.6 degrees, and mean vertebral kyphosis to -26.6 degrees from 17.7 degrees. In 17 patients with neurologic deficit, Frankel grades improved after surgery. No major complication occurred. All patients had improved pain, self-image, and overall satisfaction.

CONCLUSIONS

ALO and minimal segments fixation appear to hold promise for the treatment of thoracic or thoracolumbar OK, and may be safer with fewer complications. A larger series with more patients and surgeons is needed for confirmation.