The Therapeutic Effect Of Osteotomy For The Treatment Of Patients With The Spinal Sagittal Kyphotic Deformity In Thoracolumbar Fracture

Bground and ObjectiveThe thoracolumbar spine is located at the junction of the thoracic spine and the lumbar spine.It is the transition point from relatively fixed thoracic spine to lumbar spine which has a relatively large degree of motion.It is also the transition point from anterior curvature to backward curvature.At the same time,it is transition point of zygapophyseal joints from thoracic spine to lumbar spine^[1].If the thoracolumbar fracture is not timely treated or improperly treated,it will become an old fracture.With the increase of stress and the passage of time,the spinal instability will cause excessive kyphosis of thoracolumbar spine with intractable pain in the thoracolumbar and neurological dysfunction,which is named spinal sagittal kyphotic deformity in thoracolumbar fracture and neurological dysfunction.Most of the deformities belong to rigid kyphotic deformities,which often require surgical correction.Spinal osteotomy is an effective way to achieve this goal.Pedicle Subtraction Osteotomy（PSO）and Intervertebral Wedge Osteotomy（IWO,also known as"sandwich"osteotomy）are two commonly used standard clinical technology.How to choose the right osteotomy of the two kinds of surgical methods and grasp the surgical indications of different patients,especially for the surgical treatment of spinal sagittal kyphotic deformity in thoracolumbar fracture,has become a problem that needs urgent study and solution.The selection of surgical methods has become a problem that needs to be studied and solved urgently.It is still a dispute between domestic and foreign scholars.Therefore,there are two purposes of this study:（1）to study the clinical effects of Pedicle Subtraction Osteotomy and Intervertebral Wedge Osteotomy for the postoperative correction of sagittal surface for patients with spinal sagittal kyphotic deformity in thoracolumbar fracture;（2）to compare the difference of postoperative symptom between Pedicle Subtraction Osteotomy and Intervertebral Wedge Osteotomy for the treatment of spinal sagittal kyphotic deformity in thoracolumbar fracture.The resuluts will provide a basis for the choice of surgical methods for the treatment of patients with spinal sagittal kyphotic deformity in thoracolumbar fracture.MethodsStatistics of all patients with the spinal sagittal kyphotic deformity in old thoracolumbar fracture who had undergone Pedicle Subtraction Osteotomy or Intervertebral Wedge Osteotomy between September 2011 and October 2016 were retrospectively analyzed.For patients who had undergone Pedicle Subtraction Osteotomy,a total of 10 patients in this group aged 53 to 68 years had a preoperative average Cobb angle of（37.20±8.71）°;for patients who had undergone Intervertebral Wedge Osteotomy,a total of 10 patients in this group aged 49 to 75years had a preoperative average Cobb angle of（35.07±9.43）°.All subjects were followed up for more than one year.The sagittal Cobb angle,the oswestry disability index and the visual analog scale of patients with the spinal sagittal kyphotic deformity in old thoracolumbar fracture were evaluated at pre-operation,post-operation and the last follow-up.To analyze the data obtained and draw conclusions.ResultsThe patients’sagittal parameters（Cobb angle,ODI and VAS）were significantly different among pre-operation,post-operation and the last follow-up（P<0.05）.However,there were no significant difference at sagittal parameters between PSO and IWO groups in pre-operation,post-operation and the last follow-up（P>0.05）.Conclusion1.The sagittal balance of patients with the spinal sagittal kyphotic deformity in old thoracolumbar fracture could be well restored by either PSO or IWO.2.Both of the two surgical procedures can effectively relieve nerve compression,relieve pain,and obtain good clinical results.3.There was no significant difference in reconstruction of thoracolumbar kyphosis and postoperative efficacy between PSO and IWO.