The Correlation Of Spinal Sagittal Realignment With Health-related Quality Of Life After Osteotomy On Old Thoracolumbar Osteoporotic Fracture-related Kyphosis

Objectives:To evaluate the clinical efficacy of posterior osteotomy and correction on old thoracolumbar osteoporotic fracture-related kyphosis.To investigate the correlation of the spinal parameters with health-related quality of life（HRQoL）,and find independent radiographic parameters for improving HRQoL.Methods:Forty-eight patients（13 males and 35 females）with old thoracolumbar osteoporotic fracture-related kyphosis,treated with osteotomy and correction in the First Affiliated Hospital of Nanchang University from October 2013to March 2017,were enrolled in this study.The patients’general conditions（including age,gender,height,weight,distribution of wedging of vertebra,bone mineral density,types of osteotomies,operative time,blood loss and follow-up time）were recorded in detail.The sagittal spinal parameters,including thoracic kyphosis（TK）,thoracolumbar kyphosis（TLK）,lumbar lordosis（LL）,T₉ tilt,L₁ tilt,pelvic incidence（PI）,pelvic tilt（PT）,sacral slope（SS）,sagittal vertical axis（SVA）and spinosacral angle（SSA）,were measured based on the upright posteroanterior and lateral radiographs of total spine X-ray before surgery and follow-up.In addition,HRQoL were evaluated by Oswestry Disability Index（ODI）,SF-36 physical component score（SF-36 PCS）and Scoliosis Research Society-22 Patient Questionnaire（SRS-22）preoperative and follow-up.The changes of spinal parameters and HRQoL before surgery and final follow-up was analyzed through paired t-test.Pearson correlation analysis was performed to analyzed the correlation of parameters with HRQoL.Multiple stepwise regression analysis was used to identify independent parameters for improving HRQoL.Results:The patients’mean age is 62.9±9.6 years,weight is 61.4±10.9 kg,height is 161.1±6.4 cm,BMI is 23.7±4.2 kg/m2,lumbar spine T-score is-2.96±1.02 and total hip T-score is-2.67±0.65.The wedging of vertebra are distributed as follows:29 cases in 1 level,14 cases in 2 level and 5 cases in 3 level or more.There were 36 cases performed by partial vertebral resection and disectomy（PSO plus）,6cases performed by pedicle subtraction osteotomy（PSO）and 6 cases performed by vertebral column resection（VCR）.The mean time for operation was 210.4±39.4min,and mean blood loss was 820.2±175.4 ml.The mean follow-up time was 24.1±5.8 months.The paired t-test result shows that there are significant difference between preoperation and final follow-up in TK,TLK,LL,T₉ tilt,L₁ tilt,PT,SS,SVA and SSA（P<0.05）,as well as in ODI,SF-36 PCS and SRS-22（P<0.001）.Multiplestepwiseregressionanalysisindicatedthatthe major factors which influence ODI,SF-36 PCS and SRS-22 is TLK and PT,TLK and SVA,and TLK,respectively.Conclusions:Posterior osteotomy and correction can effectively realign spinal sagittal plane and improve HRQoL on old thoracolumbar osteoporotic fracture-related kyphosis patients.TLK is an independent sagittal plane parameter that affects HRQoL.