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http://dx.doi.org/10.3340/jkns.2021.0069

Partial Pedicle Subtraction Osteotomy for Patients with Thoracolumbar Fractures : Comparative Study between Burst Fracture and Posttraumatic Kyphosis  

Choi, Ho Yong (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine)
Jo, Dae Jean (Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine)
Publication Information
Journal of Korean Neurosurgical Society / v.65, no.1, 2022 , pp. 64-73 More about this Journal
Abstract
Objective : To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK). Methods : From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups. Results : Twenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups. Conclusion : In cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.
Keywords
Posttraumatic kyphosis; Spine trauma; Burst fracture; Spinal osteotomy;
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1 Gupta MC, Ferrero E, Mundis G, Smith JS, Shaffrey CI, Schwab F, et al. : Pedicle subtraction osteotomy in the revision versus primary adult spinal deformity patient: is there a difference in correction and complications? Spine (Phila Pa 1976) 40 : E1169-E1175, 2015   DOI
2 Dimar JR 2nd, Wilde PH, Glassman SD, Puno RM, Johnson JR : Thoracolumbar burst fractures treated with combined anterior and posterior surgery. Am J Orthop (Belle Mead NJ) 25 : 159-165, 1996
3 El Masry WS, Tsubo M, Katoh S, El Miligui YH, Khan A : Validation of the American Spinal Injury Association (ASIA) motor score and the National Acute Spinal Cord Injury Study (NASCIS) motor score. Spine (Phila Pa 1976) 21 : 614-619, 1996   DOI
4 Esses SI, Botsford DJ, Kostuik JP : Evaluation of surgical treatment for burst fractures. Spine (Phila Pa 1976) 15 : 667-673, 1990   DOI
5 Heary RF, Bono CM : Pedicle subtraction osteotomy in the treatment of chronic, posttraumatic kyphotic deformity. J Neurosurg Spine 5 : 1-8, 2006   DOI
6 Kavadi N, Tallarico RA, Lavelle WF : Analysis of instrumentation failures after three column osteotomies of the spine. Scoliosis Spinal Disord 12 : 19, 2017   DOI
7 Kirshblum SC, Memmo P, Kim N, Campagnolo D, Millis S : American Spinal Injury Association: comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines. Am J Phys Med Rehabil 81 : 502-505, 2002   DOI
8 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   DOI
9 Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K : Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. J Bone Joint Surg Am 85 : 454-463, 2003   DOI
10 Cahueque M, Cobar A, Zuniga C, Caldera G : Management of burst fractures in the thoracolumbar spine. J Orthop 13 : 278-281, 2016   DOI
11 Denis F : The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 8 : 817-831, 1983   DOI
12 Kraemer WJ, Schemitsch EH, Lever J, McBroom RJ, McKee MD, Waddell JP : Functional outcome of thoracolumbar burst fractures without neurological deficit. J Orthop Trauma 10 : 541-544, 1996   DOI
13 Lin B, Chen ZW, Guo ZM, Liu H, Yi ZK : Anterior approach versus posterior approach with subtotal corpectomy, decompression, and reconstruction of spine in the treatment of thoracolumbar burst fractures: a prospective randomized controlled study. J Spinal Disord Tech 25 : 309-317, 2012
14 DeWald RL : Burst fractures of the thoracic and lumbar spine. Clin Orthop Relat Res 189 : 150-161, 1984   DOI
15 Daubs MD, Lenke LG, Cheh G, Stobbs G, Bridwell KH : Adult spinal deformity surgery: complications and outcomes in patients over age 60. Spine (Phila Pa 1976) 32 : 2238-2244, 2007   DOI
16 Defino HL, Rodriguez-Fuentes AE : Treatment of fractures of the thoracolumbar spine by combined anteroposterior fixation using the Harms method. Eur Spine J 7 : 187-194, 1998   DOI
17 Sasani M, Ozer AF : Single-stage posterior corpectomy and expandable cage placement for treatment of thoracic or lumbar burst fractures. Spine (Phila Pa 1976) 34 : E33-E40, 2009   DOI
18 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   DOI
19 Knop C, Fabian HF, Bastian L, Blauth M : Late results of thoracolumbar fractures after posterior instrumentation and transpedicular bone grafting. Spine (Phila Pa 1976) 26 : 88-99, 2001   DOI
20 Li S, Li Z, Hua W, Wang K, Li S, Zhang Y, et al. : Clinical outcome and surgical strategies for late post-traumatic kyphosis after failed thoracolumbar fracture operation: case report and literature review. Medicine (Baltimore) 96 : e8770, 2017   DOI
21 Smith JS, Klineberg E, Lafage V, Shaffrey CI, Schwab F, Lafage R, et al. : Prospective multicenter assessment of perioperative and minimum 2-year postoperative complication rates associated with adult spinal deformity surgery. J Neurosurg Spine 25 : 1-14, 2016.   DOI
22 Divi SN, Schroeder GD, Oner FC, Kandziora F, Schnake KJ, Dvorak MF, et al. : AOSpine-spine trauma classification system: the value of modifiers: a narrative review with commentary on evolving descriptive principles. Global Spine J 9 (1 Suppl) : 77S-88S, 2019   DOI
23 Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K : Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Am 86-A Suppl 1 : 44-50, 2004
24 McDonough PW, Davis R, Tribus C, Zdeblick TA : The management of acute thoracolumbar burst fractures with anterior corpectomy and Z-plate fixation. Spine (Phila Pa 1976) 29 : 1901-1908; discussion 1909, 2004   DOI
25 Muller U, Berlemann U, Sledge J, Schwarzenbach O : Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: bisegmental stabilization with monosegmental fusion. Eur Spine J 8 : 284-289, 1999   DOI
26 Munting E : Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects. Eur Spine J 19 Suppl 1 (Suppl 1) : S69-S73, 2010   DOI
27 Wood K, Buttermann G, Mehbod A, Garvey T, Jhanjee R, Sechriest V : Operative compared with nonoperative treatment of a thoracolumbar burst fracture without neurological deficit. A prospective, randomized study. J Bone Joint Surg Am 85 : 773-781, 2003.   DOI
28 Xi YM, Pan M, Wang ZJ, Zhang GQ, Shan R, Liu YJ, et al. : Correction of post-traumatic thoracolumbar kyphosis using pedicle subtraction osteotomy. Eur J Orthop Surg Traumatol 23 Suppl 1 : S59-S66, 2013
29 Holmes JF, Miller PQ, Panacek EA, Lin S, Horne NS, Mower WR : Epidemiology of thoracolumbar spine injury in blunt trauma. Acad Emerg Med 8 : 866-872, 2001   DOI
30 La Maida GA, Luceri F, Gallozzi F, Ferraro M, Bernardo M : Complication rate in adult deformity surgical treatment: safety of the posterior osteotomies. Eur Spine J 24 Suppl 7 : 879-886, 2015   DOI
31 Carl AL, Tromanhauser SG, Roger DJ : Pedicle screw instrumentation for thoracolumbar burst fractures and fracture-dislocations. Spine (Phila Pa 1976) 17(8 Suppl) : S317-S324, 1992
32 Choi HY, Hyun SJ, Kim KJ, Jahng TA, Kim HJ : Radiographic and clinical outcomes following pedicle subtraction osteotomy: minimum 2-year follow-up data. J Korean Neurosurg Soc 63 : 99-107, 2020   DOI
33 Yang BP, Ondra SL, Chen LA, Jung HS, Koski TR, Salehi SA : Clinical and radiographic outcomes of thoracic and lumbar pedicle subtraction osteotomy for fixed sagittal imbalance. J Neurosurg Spine 5 : 9-17, 2006   DOI
34 Murrey DB, Brigham CD, Kiebzak GM, Finger F, Chewning SJ : Transpedicular decompression and pedicle subtraction osteotomy (eggshell procedure): a retrospective review of 59 patients. Spine (Phila Pa 1976) 27 : 2338-2345, 2002   DOI
35 Sasso RC, Renkens K, Hanson D, Reilly T, McGuire RA Jr, Best NM : Unstable thoracolumbar burst fractures: anterior-only versus short-segment posterior fixation. J Spinal Disord Tech 19 : 242-248, 2006   DOI
36 Schoenfeld AJ, Wood KB, Fisher CF, Fehlings M, Oner FC, Bouchard K, et al. : Posttraumatic kyphosis: current state of diagnosis and treatment: results of a multinational survey of spine trauma surgeons. J Spinal Disord Tech 23 : e1-e8, 2010   DOI
37 Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. : AOSpine thoracolumbar spine injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976) 38 : 2028-2037, 2013   DOI
38 Vaccaro AR, Silber JS : Post-traumatic spinal deformity. Spine (Phila Pa 1976) 26 : S111-S118, 2001   DOI
39 Wood KB : Commentary of acute and hyperacute thoracolumbar corpectomy for traumatic burst fractures using a mini-open lateral approach. Spine (Phila Pa 1976) 43 : E125, 2018   DOI
40 Wood KB, Bohn D, Mehbod A : Anterior versus posterior treatment of stable thoracolumbar burst fractures without neurologic deficit: a prospective, randomized study. J Spinal Disord Tech 18 Suppl : S15-S23, 2005   DOI
41 Zhang X, Zhang X, Zhang Y, Wang Z, Wang Y : Modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. J Trauma 71 : 209-216, 2011   DOI
42 Daubs MD, Brodke DS, Annis P, Lawrence BD : Perioperative complications of pedicle subtraction osteotomy. Global Spine J 6 : 630-635, 2016   DOI