Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures with kyphosis deformity / 中华创伤杂志

ABSTRACT

Objective To analyze the clinical results of mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation for old thoracolumbar compression fractures combined with kyphosis deformity.Methods A retrospective case series study was made on 14 patients with old thoracolumbar compression fractures combined with thoracolumbar kyphosis undergone mini-incision Schwab grade 4 osteotomy plus percutaneous pedicle screw fixation from January 2014 to May 2015.There were 5 males and 9 females,with mean age of 64.5 years (range,58-70 years).The period between injury and surgery ranged between 6 and 14 months (mean,8.6 months).At the time of surgery,the fracture was already healed in 10 patients,while non-healing was found in other 4 patients.Preoperative visual analogue score (VAS) of back pain was (8.5 ± 1.1)points (range,6.5-10 points).Three patients were associated with neurological dysfunction [American Spinal Injury Association (ASIA) grade D].Apex of kyphosis located at T12 in 6 patients and at L1 in 8 patients.Preoperative kyphosis Cobb angle was (42.5 ± 6.0)° (range,39.5°-47.2°).Operation time,blood loss,perioperative complications,postoperative kyphosis Cobb angle,bone fusion,state of implants,neurological function and VAS were determined.Results Operation time was (280 ± 50) min,and blood loss was (110 ±70)ml.No segmental vessels injury,neurological deficit or dural disruption occurred during the surgery and after surgery.Compared to the preoperative detection,kyphosis Cobb angle was improved to (9.3 ±1.7) ° (range,6.2°-12.1 °) after operation (P ＜ 0.05),with the correction rate of 78.1％.Postoperative CT showed 7 screws (6.3％,7/112) were grade 1 screws.The follow-up was lasted for mean 25.2 months (range,14-28.9 months).At the latest follow-up,the kyphosis Cobb angle was (9.6 ±4.1)°(range,6.0°-13.1°),revealing no correction loss.Interbody bone fusion was good,with no instrumentation-related complications observed.Three patients with neurological dysfunction (ASIA grade D) were recovered to ASIA grade E.Compared to the preoperative detection,back pain was improved with the VAS of (2.6 ± 1.0) points at the latest follow-up (P ＜ 0.05).Conclusion Mini-incision Schwab grade 4 osteotomy combined with percutaneous pedicle screw fixation of old thoracolumbar compression fractures with kyphosis deformity can attain satisfactory and reliable efficacy and bone fusion,with low incidence of complications.