Observation on efficacy of trans pedicular and trans vertebral disc osteotomy in treatment of rigid kyphosis

Abstract:

Objective:To evaluate the efficacy of trans pedicular and trans-vertebral disc osteotomy in the treatment of kyphosis and to discuss its indications.Methods：Twenty-five patients with kyphosis deformity were surgically treated with trans pedicular and trans vertebral disc osteotomy including 15 males and 10 females with the average age of 48.6 years old (from 8 to 69 years old).There were 19 cases of post traumatic kyphosis and 6 cases of congenital kyphosis with scoliosis. The preoperative mean kyphotic Cobb angle was (40.56±11.05)°.According to the Frankel grading system, 1 case was classified as grade C, 1 case as grade D and 23 cases as grade E preoperatively. All the patients had severe thoracolumbar dorsum pain with difficulty of lying flat. There were 2 cases complicated with bladder sphincter dysfunction and 4 cases of congenital kyphosis underwent progressive deformities.Results：All surgeries were finished successfully. The operation time was 3.0～6.0 h (averaged 4.5 h) and the perioperative bleeding was 800～2 500 ml (averaged 1 550 ml). All incisions were healed by the first intention with no infection or deep venous thrombosis being observed. All cases were followed up from 12～28 months (averaged 18 months). No pseudoarthrosis and implant failure were occurred. Preoperative back pain was allievated in all cases. Neurologic improvement was occurred in 1 case from Frankel grade C to grade D after the surgery. The bladder sphincter function were also improved in 2 cases postoperatively.The Cobb angles of kyphosis at one week after the operation and the last follow-up were obviously improved when compared with the preoperative ones, showing significant differences (P<0.05).No obvious correction loss was observed either in coronal or sagittal plane. Conclusion：Trans-pedicular and trans-vertebral disc osteotomy is an effective and safe surgical technique for kyphosis.