Modified grade 4 osteotomy for the correction of post-traumatic thoracolumbar kyphosis

Liu, Fengyu; Gu, Zhen-Fang; Zhao, Zheng-Qi; Ren, Liang; Wang, Limin; Yu, Jiang; Hou, Shuxun; Ding, Wenyuan; Sun, Xian-Ze

doi:10.1097/md.0000000000022204

Cited by 7 publications

(6 citation statements)

References 27 publications

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“…The osteotomy sites were usually chosen at the apex of the deformity, and posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), modified grade 4 osteotomy, and vertebral column resection (VSR) were chosen depending on the severity and pattern of the curvature. 18 , 19 PCO includes Smith–Petersen osteotomy (SPO) and Ponte osteotomy. SPO involves resection of the lower facet joint and joint capsule.…”

Section: Methodsmentioning

confidence: 99%

Distal Junctional Failures in Degenerative Thoracolumbar Hyperkyphosis

Wang,

Li,

et al. 2024

Orthopaedic Surgery

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ObjectiveDegenerative thoracolumbar hyperkyphosis (DTH) is a disease that negatively affects individual health and requires surgical intervention, yet the ideal surgical approach and complications, especially distal junctional failures (DJF), remain poorly understood. This study aims to investigate DJF in DTH and to identify the risk factors for DJF so that we can improve surgical decision‐making, and advance our knowledge in the field of spinal surgery to enhance patient outcomes.MethodsThis study retrospectively reviewed 78 cases (late osteoporotic vertebral compression fracture [OVCF], 51; Scheuermann's kyphosis [SK], 17; and degenerative disc diseases [DDD], 10) who underwent corrective surgery in our institute from 2008 to 2019. Clinical outcomes were assessed using health‐related quality of life (HRQOL) measures, including the visual analogue scale (VAS) scores for back and leg pain, the Oswestry disability index (ODI), and the Japanese Orthopaedic Association (JOA) scoring system. Multiple radiographic parameters, such as global kyphosis (GK) and thoracolumbar kyphosis (TLK), were assessed to determine radiographic outcomes. Multivariate logistic regression analysis was employed to identify the risk factors associated with DJF.ResultsHRQOL improved, and GK, TLK decreased at the final follow‐up, with a correction rate of 67.7% and 68.5%, respectively. DJF was found in 13 of 78 cases (16.7%), two cases had wedging in the disc (L3‐4) below the instrumentation, one case had a fracture of the lowest instrumented vertebrae (LIV), one case had osteoporotic fracture below the fixation, nine cases had pull‐out or loosening of the screws at the LIV and three cases (23.1%) required revision surgery. The DJF group had older age, lower computed tomography Hounsfield unit (CT HU), longer follow‐up, more blood loss, greater preoperative sagittal vertical axis (SVA), and poorer postoperative JOA and VAS scores (back). The change in TLK level was larger in the non‐DJF group. Post‐sagittal stable vertebrae (SSV) moved cranially compared with pre‐SSV.ConclusionAge, CT HU, length of follow‐up, estimated blood loss, and preoperative SVA were independent risk factors for DJF. We recommend fixation of the two vertebrae below the apex vertebrae for DTH to minimize surgical trauma.

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Section: Methodsmentioning

confidence: 99%

Distal Junctional Failures in Degenerative Thoracolumbar Hyperkyphosis

Wang,

Li,

et al. 2024

Orthopaedic Surgery

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“…In recent 20 years, RPTK has achieved good clinical e cacy through PSO or modi ed PSO technology, [5][6][7][8][9][10][11][12][13] but there are some complications such as large amount of osteotomy, severe trauma, excessive blood loss, severe spinal cord shortening, and spinal cord injury. It has been reported that classical transpedicular osteotomy technique or modi ed pedicle osteotomy technique removes half of the pedicle and half of the vertebral body combined with the injured disc, which can lead to the intraoperative blood loss of up to 1500-2200 mL.…”

Section: Discusssionmentioning

confidence: 99%

“…It has been reported that classical transpedicular osteotomy technique or modi ed pedicle osteotomy technique removes half of the pedicle and half of the vertebral body combined with the injured disc, which can lead to the intraoperative blood loss of up to 1500-2200 mL. [5][6][7][8][9] Hua et al…”

Section: Discusssionmentioning

confidence: 99%

“…Common orthopedic strategies for RPTK include anterior subtotal vertebral resection, posterior Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), and posterior-anterior approach. [1][2][3][4][5][6][7][8][9][10][11][12][13] Many surgeons have used grade III or grade IV osteotomy technique for RPTK [5][6][7][8][9] since Schwab proposed a systematic osteotomy technique for kyphosis in 2014. 4 According to previous literature and clinical observations, the main imaging features of RPTK patients are as follows: 1) severe wedge-shaped lesions of the injured vertebra 14 ; 2) scar formation of the anterior longitudinal ligament, and callus can be found in some patients [15][16][17] ; 3) posterior facet stiffness with spontaneous traumatic bone fusion 18 ; 4) a certain distance between the anterior longitudinal ligament callus and the abdominal aorta and vein.…”

Section: Introdutionmentioning

confidence: 99%

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Treatment of rigid post-traumatic thoracolumbar kyphosis by a novel technique of spinal joints release

Wang

Tang

Wang

et al. 2022

Preprint

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Objective The purpose of this study was to evaluate the feasibility of a novel technique named spinal joints release (SJR) and observe its efficacy in treating rigid post-traumatic thoracolumbar kyphosis (RPTK).Methods RPTK patients who were treated by SJR with facet resection, limited laminotomy, clearance of the intervertebral space, and release of the anterior longitudinal ligament through the intervertebral foramen from August 2015 to August 2021 were reviewed. Operation time and intraoperative blood loss were recorded. The intraoperative, postoperative, and final follow-up complications were observed. The improvement in VAS score and ODI index were observed. Spinal cord functional recovery was evaluated by ASIA score. Improvement of local kyphosis (Cobb) was evaluated by radiography.Results Forty-three patients were successfully treated by the SJR surgical technique. There were no serious complications. The average operation time was 224 ± 31 min, and intraoperative blood loss was 450 ± 225 mL. All of the patients were followed up with an average of 26 ± 8.5 months. The VAS scores and ODI index improved significantly at the final follow-up. All of the 17 patients with incomplete spinal cord injury achieved more than one grade neurological recovery at the final follow-up. An 87% correction rate of kyphosis was achieved and maintained, with the Cobb angle decreasing from 27.7° preoperatively to 5.4° at the final follow-up.Conclusion Posterior SJR surgery for patients with RPTK has the advantages of less trauma and less blood loss, and kyphosis correction is satisfactory.

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“…(2015) reported similar techniques correcting kyphotic deformities , while the fulcrum of the osteotomy closure was modified more dorsally for a larger correction angle. Afterwards, many other scholars reported similar techniques via the trans-intervertebral approach, while there were nuances between each technique in osteotomy correction geometry ( Obeid et al., 2018 ; Liu et al., 2020 ). However, the terminology of these osteotomies was confusing and lies beyond the Schwab-SRS osteotomy classification.…”

Section: Introductionmentioning

confidence: 99%