| BackgroundThoracolumbar kyphosis is a common spinal deformity. The kyphosis deformity is usually caused by congenital spine malformation, old thoracolumbar fracture, spinal tuberculosis, Scheuermann's disease, ankylosing spondylitis, vertebral tumors, achondroplasia, etc. In addition to diseases of the spine itself, the deformity can also caused by abdominal cancer.The Normal thoracic kyphosis angle is usually less than 50°, kyphosis apex is at T6-T8, forms the physiological balanced curvature with lumbar lordosis。Thus the vertical line is at C1, T1, T12 and S1, to keep a best physiological curve, body balance and with forward vision。In Normal spinal curvature, the vertical line should go through all physical segment conjunction, the center of gravity of the upper body is located at the front thoracic vertebrae。Thoracolumbar kyphosis angle or short arc kyphosis makes the gravity center of the body above the injured level move forward, and worsen the kyphosis.When thoracolumbar kyphosis occurs, the body keep its balance mainly through excessive lumbar lordosis .Normally the center of gravity above the thoracolumbar spine lies at the front part of the thoracic vertebrae, by excessive compensatory lumbar lordosis, the gravity center of the body above the injured level move forward, and worsen the kyphosis. If kyphosis angle is greater than 60°, the deformity would continue to deteriorate and lead to backache or even paralysis, so this needs orthodontic treatment. But specific conditions about compensatory lumbar lordosis, problems caused by this and countermeasures to this is unclear。With our country stepping into aging society, patients with thoracolumbar kyphosis are growing, this kind of kyphosis is often accompanied with local instability, increased lumbar lordosis angle, lossing of spinal supportfunction, causing low back pain, and complicated by destabilizing of upper lumbar spine and accelerating intervertebral disc degeneration, which cause great suffering to patients。For some patients, conservative treatment is not an effective method, and require surgical treatment, this brings great load on families and society.Objective:To investigate the relationship between thoracolumbar kyphosis and lumbar lordosis angle, assess the efkctiveness of osteotomy for thoracolumbar kyphosis, predict lumbar lordosis angle and sacral angle' s spontaneous correction after orthopedic fusion in thoracolumbar kyphosis patient.Methods:From June 2004 to 2009, 26 patients with thoracolumbar kyphosis treated with surgery and received follow-up study were included in the research. All patients underwent posterior approach operation,9 cases among them underwent Pedicle Subtraction Osteotomy(PSO),10 patients underwent Smith Petersen Osteotomy(SPO),7 patients underwent Vertebral Column Resection(VCR). Besides,10 cases treated with imported TSRH (texas scottish rite hospital) orthopedic,16 patients with imported CD HORIZON M8 orthopedic fixation. These cases are included in the patient group, comprise 15 males and 11 females, aged 21 to 66 years, mean age 35.2 years. 30 persons without spinal disorders and spinal X-ray examination showing normal were included in the control group, including 18 males and 12 females. Analyze patients'every spine segments of lumbar lordosis, thoracolumbar kyphosis angle, lumbar lordosis, sacral angle, vertebral slippage on pre—and postoperative X-ray,and compare them with the control group.ResultsNo major complication occurred during operation, postoperative pain was relieved notablely. Preoperative sagittal balance of the average (69.7±40.6) mm, after improving to (8.7±7.8) mm (P<0.01); mean preoperative lumbar lordosis angle (69.8±13.6)°, were followed up for less to (42.5±6.4)°(P<0.01). The mean preoperative thoracic kyphosis angle (50.8±11.9)°, after reduced to (12.4±4.7)°. Preoperative thoracolumbar kyphosis and lumbar lordosis correlated (r=0.772, P <0.01), thoracolumbar kyphosis and the lumbosacral angle correlation (r =0.782, P<0.01); after thoracic surgery convex correlation with increased lumbar lordosis (r=0.672, P<0.01). Postoperative thoracolumbar kyphosis associated with increased lumbosacral angle (r= 0.682, P<0.01). Disease group the lumbar lordosis angle and lumbar lordosis angle compared to the normal group there was significant difference (P<0.01), and the greater increase in lumbar lordosis angle, excessive lumbar lordosis after surgery showed significant correction, but still slightly larger than normal group. Preoperative NRS score was 7.8±1.3, postoperative 2.3±1.7 (P<0.01); preoperative ODI score was 56.8%±11.7%, surgery was 29.7%±13.5%(P<0.01); after 24 patients (92%) on treatment outcomes are very satisfied or satisfied.ConclusionsRigorous assessment of the preoperative selection of suitable osteotomy, complete nerve decompression, deformity correction as much as possible, and the reconstruction of spinal sagittal balance is the treatment of thoracolumbar kyphosis critical success factors, a single posterior approach can reduce the risk of surgery; thoracolumbar kyphosis in patients with thoracolumbar kyphosis and lumbar lordosis in the sagittal reciprocal relationship exists, after osteotomy of thoracolumbar kyphosis statistics can bring high levels of lumbar lordosis improved stability of this reciprocal relationship can be maintained. |
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