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| Effect of combined osteotomy with Mu-PVCR and modified TIO in treatment of elderly multi-segmental thoracolumbar fractures with kyphosis |
| WANG Changfeng, YANG Le |
| Department of Orthopedics, Jiangsu Provincal Corps Hospital of Chinese People’s Armed Police Force, Yangzhou 225003, China |
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Abstract Objective To investigate the effect of combined modified unilateral posterior vertebral osteotomy (MU-PVCR) and modified trans-intervertebral space osteotomy(TIO) in elderly patients with multi-segmental thoracolumbar fractures with kyphosis.Methods From March 2011 to January 2020, 17 patients with elderly multi-segmental thoracolumbar fractures with kyphosis were treated in Jiangsu Provincal Corps Hospital of Chinese People’s Armed Police Force by combined osteotomy of MU-PVCR and modified TIO. The changes of sacral slope (SS), sagittal vertical axis (SVA), ODI score, VAS score, JOA score, Cobb angle and intervertebral height before and after surgery were recorded to observe whether there was a proximal junction kyphosis (PJK) during follow-up.Results The group was followed up for 1.2-4.3 years. VAS scores, ODI scores and JOA scores at the last follow-up (2.6±0.5) were significantly improved compared with those before operation (6.9±1.8, 7.4%±2.8% and 13.08±3.81 respectively) (P<0.05). Neurologic function was normal in 15 cases before operation. Two patients with Frankel grade D were followed up to grade E 6 months after surgery. PJK occurred in 3 patients, respectively at the follow-up from 8 to 15 months after surgery. In 1 case, the farthest screw was slightly pulled out, and the displacement was about 6mm. At the last follow-up, the Cobb angle of thoracolumbar kyphosis (20.2°±4.4°) significantly reduced compared with that before surgery (61.5°±10.5°) (P< 0.05), and the intervertebral height [(34.72±3.04) mm] significantly increased compared with that before surgery [(12.09±4.08) mm] (P< 0.05). There were no significant changes in the Cobb angle of thoracolumbar kyphosis or intervertebral height at the last follow-up compared with 6 months after surgery.Conclusions Combined MU-PVCR and modified TIO osteotomy and long segmental fixation in treatment of elderly multi-segmental thoracolumbar fractures with kyphosis can achieve satisfactory correction and clinical therapeutic effect with simplified surgery.
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Received: 02 December 2022
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2023, Vol. 34 
