Zeng Yan, Chen Zhongqiang, Guo Zhaoqing, Qi Qiang, Li Weishi, Sun Chuiguo
Orthopedic Department, Peking University Third Hospital, No 49. North Garden Street, Beijing, 100191, China.
Eur Spine J. 2014 Nov;23(11):2291-8. doi: 10.1007/s00586-014-3414-8. Epub 2014 Jun 21.
To analyze the clinical characteristics of focal kyphosis in upper thoracic spine, and observe the outcome of the posterior corrective surgical procedures.
Thirteen patients of focal kyphosis were treated with posterior surgical procedures in our medical center. The kyphosis apex was above T6 in all cases. The surgical procedures performed in this study included pedicle subtraction osteotomy (PSO) in six cases and vertebral column resection (VCR) in seven cases. For each case, the kyphosis angle, curvature of lower thoracic spine, lumbar lordosis angle, cervical lordosis angle, pelvic parameters, and the sagittal plane balance of the spine were compared before and after surgery. Neurological function change was assessed based on Frankel grading system and oswestry disability index (ODI).
The average follow-up time of this study was 28.3 months. The average kyphosis angle was reduced from 73.5º before surgery to 32.7º immediately after surgery, and remained at 33.5º at follow-up. The average ODI improved from 22.5 before surgery to 15.5 at follow-up. The neurological function improved after surgery in eight cases. There were two cases of transient neurological deficiency in the lower extremities after VCR procedure, who eventually recovered under postoperative care. One case had recurrent kyphosis due to implant failure after VCR procedure, and recovered after the revision surgery.
Although high risk needs to be warned, the corrective surgery for focal kyphosis in upper thoracic spine still can achieve satisfactory results. Given the comparative surgical results yet less complications, PSO seems to be a preferable procedure over VCR for kyphosis at this region.
分析上胸椎局灶性后凸畸形的临床特征，并观察后路矫正手术的疗效。
本医疗中心对13例上胸椎局灶性后凸畸形患者实施了后路手术。所有病例的后凸顶点均位于T6以上。本研究中实施的手术包括6例经椎弓根截骨术（PSO）和7例全脊椎切除术（VCR）。对每例患者，比较手术前后的后凸角度、下胸椎曲度、腰椎前凸角、颈椎前凸角、骨盆参数以及脊柱矢状面平衡情况。基于Frankel分级系统和Oswestry功能障碍指数（ODI）评估神经功能变化。
本研究的平均随访时间为28.3个月。平均后凸角度从术前的73.5°降至术后即刻的32.7°，随访时保持在33.5°。平均ODI从术前的22.5改善至随访时的15.5。8例患者术后神经功能改善。VCR手术后有2例出现下肢短暂性神经功能障碍，经术后护理最终恢复。1例VCR手术后因内固定失败出现后凸畸形复发，翻修手术后恢复。
尽管需要警示高风险，但上胸椎局灶性后凸畸形的矫正手术仍可取得满意疗效。鉴于手术效果相当但并发症较少，对于该区域的后凸畸形，PSO似乎是比VCR更优的手术方式。
