Analysis Of Curative Effect Of Thoracolumbar Kyphosis Secondary Low Back Pain By Osteotomy And Correction

Background: Thoracolumbar kyphosis deformity,with or no t local pain,will lead to spinal sagittal imbalance.Lumbar hyperlordosis must be occurred as a compensatory mechanism to maintain an upright position and horizontal gaze,which cause lumbar facet osteoarthritis,and subsequently resulting in low back pain.Objective: To investigate the surgery project and curative effect of low back pain secondary to patients with thoracolumbar kyphosis deformity b y osteotomy and correction combined with pedicle instrumentation.Methods: Twelve consecutive adult patients on whom the senior spine surgeon performed osteotomy for sagittal imbalance caused by thoracolumbar kyphosis between August 2013 and August 2015 were enrolled.These participant were from the hospitalization of the Departm ent of spine surgery in the Dalian Medical University.Selective criteria including:(1)confirmed diagnosis as thoracolumbar kyphosis deformity;among twelve subjects,8 cases posttraumatic vertebrae wedging union,and 4 cases compression wedging fracture for aging osteoporosis;(2)complained of low back pain and fatigue in standing position instead of sitting position;Among these participates,7 cases with pain in thoracolumbar junction,and 6 cases experienced intercostal neur algia.(3)all patients with spinal compensated sagittal imbalance and compensatory lumbar hyperlordosis;(4)positive radiographic outcomes of lower lumbar vertebrae with facet osteoarthritis.Among these subjects,4 cases were male and 8 were female.The age was ranged from 52 to 74 years old,with an average of 63.1±5.62 years old.The follow-up period was ranged 8 to 18 months,with an average of 13.6 ± 4.37 months.After they were admitted to the hospital,all patients were taken careful inquiry and ph ysical examination,and then anteroposterior and lateral film,dynamic radiographs,CT and magnetic resonance imaging of thoracic and lumbar spine and full standing X-ray film of spine.In this way,we may obtain a comprehensive understanding in spinal curvature,flexibility of deformity,spinal canal and the facet joint and nerve compression of patients in order to determine more appropriate operation plan.The simulated oste otomy was performed on the picture before operation.All patients underwent posterior osteotomy and correction at kyphosis deformity with pedicle screw-rod internal fixation.Data collection of patients during preoperation and postoperation including: VAS(Visual Analogue Scale/Score),ODI(Oswestry disability index)questionary score,the spinopelvic parameters of sagittal alignment in full standing X-ray lateral view of spine(including sagittal vertical axis(SVA),pelvic incidence(PI),pelvic tilt(PT),lu mbar lordosis(LL),thoracic kyphosis(TK)and Cobb angle in thoracolumbar kyphosis).All collected results were evaluated and compared with SPSS 16.0 software to assess the clinical outcomes of patients about symptoms improvement and treatment efficacy,P<0.05 was considered statistically significant.Results: All the patients in this study were successfully completed the osteotomy and internal fixation operation.The operation time was 4.1 hours in average(3.6~ 5.2 hours).The intraoperative bleeding was a bout 2350 milliliter(ml)in average(1750 ~ 3200 ml).Ever y participant used autologous blood transfusion technology,of which 8 cases applied perioperative component blood transfusion.There was no perioperative or postoperative mortality,neurological impa irment and wound related problems.Postoperative bed rest ranged beyween 4 and 10 days,(6.4 days in average).Symptoms of back pain and fatigue were significantly alleviated in all subjects,thoracolumbar pain of 7 patients relieved,preoperative intercostal neuralgia of 6 subjects nearly disappeared,and all above gradually disappeared during 2-5 months follow-up period.Spinal-pelvis parameters evaluated preoperative noted that all subjects were compensated sagittal balance(ie.Hidden sagittal imbalance).TK improved than preoperation(P < 0.05).Spinal-pelvis parameters(including SVA,LL,PT)evaluated postoperative versus preoperative shows significantl y decreased(P < 0.000);Cobb angle of thoracolumbar kyphosis lesions have been corrected 24.67±3.23 degree,were significantly improved compared with preoperative(P < 0.000);ODI score and VAS assess of patients who were followed up was significantly decreased compared with those before operation(P < 0.000).Postoperative low back pain significantly im proved and VAS improved compared with preoperation(P < 0.000).In this study,all patients during the follow-up period were not found with screw loosening,nail withdrawal,broken and rod broken phenomenon;closure of the osteotomy site is good,and all s ubjects achieved successful union.There were not local collapse and loss of correction phenomenon appeared.During the follow-up period we did not find lumbar osteoarthritis were significantly aggravated in all patients requiring reoperation.Conclusions: Low back pain secondary with thoracolumbar kyphosis is caused by compensatory lumbar hyperlordosis.The osteotomy and correction at kyphosis deformity combined with pedicle screw rod system fixation via posterior approach can be a safe and effective treat ment measure.The surgical method is a secure and reliable curative for secondary low back pain caused by thoracolumbar kyphosis deformity,because it can correct kyphosis deformity,block the aggravation of the deformity and relief low back pain due to os teoarthritis stem from compensatory factors,and effectively improve the symptoms and quality of life of patients.There were not low back pain recurring and loss of correction appeared during follow-up period.