Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis.

ABSTRACT

BACKGROUND CONTEXT Pedicle subtraction osteotomy (PSO) is the most commonly recommended technique for the correction of local post-traumatic thoracolumbar deformity; however, the surgical results are not always satisfactory because the possibly damaged upper disc is preserved, and all the posterior elements are resected. PURPOSE: The aim was to compare the results of standard PSO and modified PSO in the treatment of post-traumatic thoracolumbar kyphosis. STUDY DESIGN: This was a retrospective multicenter comparative clinical study. PATIENT SAMPLE A total of 86 patients were included in the final analysis. OUTCOME MEASURES: The outcome measures included local Cobb angle of the kyphosis, visual analog scale (VAS) score, and Oswestry disability index (ODI) score. METHODS: The upper disc was resected, and the inferior wall of the index pedicle and the lower facet joint were preserved in the modified PSO. Patients with focal kyphosis greater than 30° who were treated with one-level osteotomy, without the presence of spine neoplasm, infection, or previous surgery, were included. The measurements included the VAS score, ODI score, and preoperative and postoperative Cobb angles. RESULTS: Forty-two patients in the modified PSO group and 44 in the standard PSO group were included in the final analysis. The mean surgical time and blood loss were similar between the two groups. Both the VAS and ODI scores had improved significantly at the final follow-up in the two groups. The mean Cobb angle significantly improved from 39.6° to 5.6° in the modified PSO group and from 39.1° to 4.8° in the standard PSO group, with no significant difference between the two groups preoperatively or at the final follow-up. CONCLUSIONS: The modified PSO provides an alternative method with which to correct kyphotic deformity in patients with post-traumatic thoracolumbar kyphosis.