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Clinical Efficacy and Safety of Controlled Distraction-Compression Technique Using Expandable Titanium Cage in Correction of Posttraumatic Kyphosis

  • Kang, Dongho (Department of Neurosurgery, School of Medicine, Gyeongsang National University) ;
  • Lewis, Stephen J (Division of Orthopaedic Surgery, University Health Network, Toronto Western Hospital) ;
  • Kim, Dong-Hwan (Department of Neurosurgery, School of Medicine, Gyeongsang National University)
  • Received : 2021.06.14
  • Accepted : 2021.07.17
  • Published : 2022.01.01

Abstract

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

Keywords

Acknowledgement

This work was supported by the Gyeongsang National University Fund for Professor on Sabbatical Leave, 2018.

References

  1. Auerbach JD, Lenke LG, Bridwell KH, Sehn JK, Milby AH, Bumpass D, et al. : Major complications and comparison between 3-column osteotomy techniques in 105 consecutive spinal deformity procedures. Spine (Phila Pa 1976) 37 : 1198-1210, 2012 https://doi.org/10.1097/BRS.0b013e31824fffde
  2. Berven SH, Deviren V, Smith JA, Hu SH, Bradford DS : Management of fixed sagittal plane deformity: outcome of combined anterior and posterior surgery. Spine (Phila Pa 1976) 28 : 1710-1715; discussion 1716, 2003 https://doi.org/10.1097/01.BRS.0000083181.25260.D6
  3. Bourghli A, Boissiere L, Vital JM, Bourghli MA, Almusrea K, Khoury G, et al. : Modified closing-opening wedge osteotomy for the treatment of sagittal malalignment in thoracolumbar fractures malunion. Spine J 15 : 2574-2582, 2015 https://doi.org/10.1016/j.spinee.2015.08.062
  4. Buchowski JM, Kuhns CA, Bridwell KH, Lenke LG : Surgical management of posttraumatic thoracolumbar kyphosis. Spine J 8 : 666-677, 2008 https://doi.org/10.1016/j.spinee.2007.03.006
  5. Busscher I, Ploegmakers JJ, Verkerke GJ, Veldhuizen AG : Comparative anatomical dimensions of the complete human and porcine spine. Eur Spine J 19 : 1104-1114, 2010 https://doi.org/10.1007/s00586-010-1326-9
  6. Chang KW : Oligosegmental correction of post-traumatic thoracolumbar angular kyphosis. Spine (Phila Pa 1976) 18 : 1909-1915, 1993 https://doi.org/10.1097/00007632-199310000-00032
  7. Chang KW, Cheng CW, Chen HC, Chang KI, Chen TC : Closing-opening wedge osteotomy for the treatment of sagittal imbalance. Spine (Phila Pa 1976) 33 : 1470-1477, 2008 https://doi.org/10.1097/BRS.0b013e3181753bcd
  8. Chikhale C, Swar A, Khurjekar K : Modified vertebral column resection technique for correcting congenital rigid angular kyphosis and its effect on functional outcomes. J Clin Diagn Res 10 : RC17-RC22, 2016
  9. Cho KJ, Bridwell KH, Lenke LG, Berra A, Baldus C : Comparison of smithpetersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine (Phila Pa 1976) 30 : 2030-2037; discussion 2038, 2005 https://doi.org/10.1097/01.brs.0000179085.92998.ee
  10. El-Sharkawi MM, Koptan WM, El-Miligui YH, Said GZ : Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study. Eur Spine J 20 : 1434-1440, 2011 https://doi.org/10.1007/s00586-011-1720-y
  11. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F : The impact of positive sagittal balance in adult spinal deformity. Spine (Phila Pa 1976) 30 : 2024-2029, 2005 https://doi.org/10.1097/01.brs.0000179086.30449.96
  12. Hao CK, Li WS, Chen ZQ : The height of the osteotomy and the correction of the kyphotic angle in thoracolumbar kyphosis. Chin Med J (Engl) 121 : 1906-1910, 2008 https://doi.org/10.1097/00029330-200810010-00010
  13. Hong JY, Suh SW, Lee SH, Park JH, Park SY, Rhyu IJ, et al. : Continuous distraction-induced delayed spinal cord injury on motor-evoked potentials and histological changes of spinal cord in a porcine model. Spinal Cord 54 : 649-655, 2016 https://doi.org/10.1038/sc.2015.231
  14. Hyun SJ, Rhim SC : Clinical outcomes and complications after pedicle subtraction osteotomy for fixed sagittal imbalance patients : a long-term follow-up data. J Korean Neurosurg Soc 47 : 95-101, 2010 https://doi.org/10.3340/jkns.2010.47.2.95
  15. Ji L, Dang XQ, Lan BS, Wang KZ, Huang YJ, Wen B, et al. : Study on the safe range of shortening of the spinal cord in canine models. Spinal Cord 51 : 134-138, 2013 https://doi.org/10.1038/sc.2012.99
  16. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H : Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine (Phila Pa 1976) 26 : 391-402, 2001 https://doi.org/10.1097/00007632-200102150-00016
  17. Kawahara N, Tomita K, Kobayashi T, Abdel-Wanis ME, Murakami H, Akamaru T : Influence of acute shortening on the spinal cord: an experimental study. Spine (Phila Pa 1976) 30 : 613-620, 2005 https://doi.org/10.1097/01.brs.0000155407.87439.a2
  18. Kim SS, Cho BC, Kim JH, Lim DJ, Park JY, Lee BJ, et al. : Complications of posterior vertebral resection for spinal deformity. Asian Spine J 6 : 257-265, 2012 https://doi.org/10.4184/asj.2012.6.4.257
  19. Kostuik JP, Matsusaki H : Anterior stabilization, instrumentation, and decompression for post-traumatic kyphosis. Spine (Phila Pa 1976) 14 : 379-386, 1989 https://doi.org/10.1097/00007632-198904000-00006
  20. Lafage V, Schwab F, Vira S, Patel A, Ungar B, Farcy JP : Spino-pelvic parameters after surgery can be predicted: a preliminary formula and validation of standing alignment. Spine (Phila Pa 1976) 36 : 1037-1045, 2011 https://doi.org/10.1097/BRS.0b013e3181eb9469
  21. Lazennec JY, Neves N, Rousseau MA, Boyer P, Pascal-Mousselard H, Saillant G : Wedge osteotomy for treating post-traumatic kyphosis at thoracolumbar and lumbar levels. J Spinal Disord Tech 19 : 487-494, 2006 https://doi.org/10.1097/01.bsd.0000211296.52260.9c
  22. Lee JH, Oh HS, Choi JG : Comparison of the posterior vertebral column resection with the expandable cage versus the nonexpandable cage in thoracolumbar angular kyphosis. Clin Spine Surg 30 : E398-E406, 2017 https://doi.org/10.1097/BSD.0000000000000236
  23. Lenke LG, Newton PO, Sucato DJ, Shufflebarger HL, Emans JB, Sponseller PD, et al. : Complications after 147 consecutive vertebral column resections for severe pediatric spinal deformity: a multicenter analysis. Spine (Phila Pa 1976) 38 : 119-132, 2013 https://doi.org/10.1097/BRS.0b013e318269fab1
  24. Liu X, Yuan S, Tian Y, Wang L, Zheng Y, Li J : Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis. J Neurosurg Spine 23 : 42-48, 2015 https://doi.org/10.3171/2014.11.SPINE14710
  25. Modi HN, Suh SW, Hong JY, Yang JH : The effects of spinal cord injury induced by shortening on motor evoked potentials and spinal cord blood flow: an experimental study in Swine. J Bone Joint Surg Am 93 : 1781-1789, 2011 https://doi.org/10.2106/JBJS.I.01794
  26. Oda I, Cunningham BW, Buckley RA, Goebel MJ, Haggerty CJ, Orbegoso CM, et al. : Does spinal kyphotic deformity influence the biomechanical characteristics of the adjacent motion segments? An in vivo animal model. Spine (Phila Pa 1976) 24 : 2139-2146, 1999 https://doi.org/10.1097/00007632-199910150-00014
  27. Ozturk C, Alanay A, Ganiyusufoglu K, Karadereler S, Ulusoy L, Hamzaoglu A : Short-term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis, and kyphoscoliosis. Spine (Phila Pa 1976) 37 : 1054-1057, 2012 https://doi.org/10.1097/BRS.0b013e31823b4142
  28. Papadopoulos EC, Boachie-Adjei O, Hess WF, Sanchez Perez-Grueso FJ, Pellise F, Gupta M, et al. : Early outcomes and complications of posterior vertebral column resection. Spine J 15 : 983-991, 2015 https://doi.org/10.1016/j.spinee.2013.03.023
  29. Roberson JR, Whitesides TE Jr : Surgical reconstruction of late post-traumatic thoracolumbar kyphosis. Spine (Phila Pa 1976) 10 : 307-312, 1985 https://doi.org/10.1097/00007632-198505000-00003
  30. Wang H, Zhang D, Sun YP, Ma L, Ding WY, Shen Y, et al. : Unilateral posterior vertebral column resection for severe thoracolumbar kyphotic deformity caused by old compressive vertebrae fracture: a technical improvement. Int J Clin Exp Med 8 : 3579-3584, 2015
  31. Wang Y, Zhang Y, Zhang X, Huang P, Xiao S, Wang Z, et al. : A single posterior approach for multilevel modified vertebral column resection in adults with severe rigid congenital kyphoscoliosis: a retrospective study of 13 cases. Eur Spine J 17 : 361-372, 2008 https://doi.org/10.1007/s00586-007-0566-9
  32. Wu J, Xue J, Huang R, Zheng C, Cui Y, Rao S : A rabbit model of lumbar distraction spinal cord injury. Spine J 16 : 643-658, 2016 https://doi.org/10.1016/j.spinee.2015.12.013
  33. Xie J, Wang Y, Zhao Z, Zhang Y, Si Y, Li T, et al. : Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°. J Neurosurg Spine 17 : 540-551, 2012 https://doi.org/10.3171/2012.9.SPINE111026
  34. Yang JH, Suh SW, Modi HN, Ramani ET, Hong JY, Hwang JH, et al. : Effects of vertebral column distraction on transcranial electrical stimulation-motor evoked potential and histology of the spinal cord in a porcine model. J Bone Joint Surg Am 95 : 835-842, S1-S2, 2013 https://doi.org/10.2106/JBJS.K.00575
  35. Zeng Y, Chen Z, Sun C, Li W, Qi Q, Guo Z, et al. : Posterior surgical correction of posttraumatic kyphosis of the thoracolumbar segment. J Spinal Disord Tech 26 : 37-41, 2013 https://doi.org/10.1097/BSD.0b013e318231d6a3