J Korean Soc Spine Surg.  2005 Mar;12(1):63-68. 10.4184/jkss.2005.12.1.63.

Undercorrection of the Thoracolumbar Kyphotic Deformity in the Osteoporotic Spine Fractures

• Kang YH
• Jeon HS
• Jeon SJ
• Choi JH
• Roh SK

• KMID: 1897023
• DOI: http://doi.org/10.4184/jkss.2005.12.1.63

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To assess the efficiency of undercorrection and transpedicular screw fixation through a posterior approach in osteoporotic spine fractures with a thoracolumbar kyphotic deformity. SUMMARY OF LITERATURE REVIEW: The surgical treatment of osteoporotic spine fractures with a thoracolumbar kyphotic deformity requires extensive surgical procedures to obtain complete restoration of the sagittal alignment, but it has a few technical limitations due to insufficient mechanical stability at the bone-screw interface. A special strategy is essential for transpedicular screw fixation for osteoporotic spine fractures with a thoracolumbar kyphotic deformity.
MATERIALS AND METHODS
We reviewed 14 osteoporotic spine fracture cases, with a thoracolumbar kyphotic deformity, which had undergone undercorrection and transpedicular screw fixation through a posterior approach, between March 2000 and June 2003, with an average follow-up period of 15. 2 months. According to the Jikei grade of the osteoporosis, 9 and 5 cases were grades 2 and 3, respectively. As a radiographic assessment, we measured the kyphotic angles of the fused segments on the preoperative, postoperative and last follow up thoracolumbar lateral views on standing using Cobb's method, and also assessed the kyphotic angle correction (KAC). The clinical results were evaluated at the last follow-up.
RESULTS
The kyphotic angles at the preoperative, postoperative and last follow-up were 33.5 degrees +/- 9.3, 22.4 degrees +/- 6.9 and 24.7 degrees +/- 6.8, respectively. We obtained a mean KAC gain of 11.1 degrees postoperatively (p<0.05), but a loss of 2.3 degrees at the last follow-up (p>0.05). The clinical results were analyzed as good, fair and poor in 8, 5 and 1 case, respectively. Fusions were achieved in all cases.
CONCLUSIONS
Undercorrection and transpedicular screw fixation for a thoracolumbar kyphotic deformity in osteoporotic spine fractures can be one of the alternatives to avoid fixation failure and an extensive surgical procedure.

Keyword

Thoracolumbar spine; Fracture; Osteoporosis; Kyphosis; Undercorrection

MeSH Terms

Congenital Abnormalities*
Follow-Up Studies
Kyphosis
Osteoporosis
Retrospective Studies
Spine*

Figure

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  Fig. 1. 65-year-old female with osteoporotic compression fracture at T11/T12/L1/L2 associated with posttraumatic kyphoscoliosis. Preoperative AP and lateral radiographs show Jikei grade III/III osteoporosis with 35° of T10 to L2 kyphosis. Fig. 1. 3 years ago, vertebroplasty performed for compression fracture T11/T12 (A). Postoperative radiographs after kyphosis correction T10 to L2, percutaneous vertebroplasty for L1/L2 and PMMA augmentation for Rt T10, L3, L4 and L5 show correcrion of T10 to L2 kyphotic angle to 30° (B). The 16 months followup radiograph shows no loss of correction and no device-related problems (C).

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