Application Of Posterior Approach Osteotomy With Screw Rod Fixation And Cage Inserting Anteriorly In Late Kyphosis Deformity

Objectives To retrospectively analyze the clinical efficacy of posterior posterior osteotomy,rod fixation and anterior and middle column height in the treatment of delayed kyphosis,and evaluate the safety,rationality and operative indications of this technique.Methods From January 2014 to December 2016 in our hospital were delayed spinal kyphosis were 28 cases,16 cases were male,12 female;age16-70 years(mean 41 years);History of 12-96 months(average 52 months);Preoperative kyphosis in cervicothoracic vertebrae 1 cases,thoracic vertebrae in 6 cases.7 cases of thoracolumbar and lumbar vertebrae in 14 cases,including 6 cases involving a vertebral body,2 vertebral bodies in 18 cases,2vertebrae above 4 cases.The Cobb angle of kyphosis was 44.964 + 10.747 degrees before operation;26 cases of patients with spinal cord injury,according to the Frankel classification: 2 cases of Grade A,5 cases of grade B,9 cases of grade C grade D,8 cases;14 cases of spinal tuberculosis patients,8cases were injured after conservative treatment of patients,6 cases had the history of operation.Results All patients were followed up for 12~36 months,with an average of 21.4 months.The operation time was 200~280 minutes,with an average of 238 minutes.The amount of bleeding was 420~1250,average699 ml,and the blood transfusion was 300 to 680 ml,with an average of 450 ml.4~10 vertebral bodies were fixed at the fixed stage with an average of 6vertebral bodies.Perioperative cerebrospinal fluid leakage in 2 cases,tuberculosis recurrence in 1 cases,poor wound healing in 2 cases,preoperative and postoperative Cobb angle of 44.964 + 10.748 degrees,postoperative Cobb angle 11.364 11.364.Preoperative vertebral height was1.284 0.360 cm,postoperative anterior vertebral height was 2.064 + 0.345 cm,before and after the operation statistics have obvious difference(P<0.05);preoperative vertebral height was 2.4075 0.355 cm,postoperative vertebral height was 2.192 + 0.324 cm,before and after the operation statistics have obvious difference(P<0.05);wedge angle before operation 30.357.7.093,after 9.179 + 3.399.Postoperative follow-up VAS score was 1.714 + 1.436 and7.785 + 1.166 before surgery,there was significant difference before and after surgery(P<0.05);postoperative follow-up ODI index was 10.560% + 3.392%and 70.679% + 5.518% before surgery,there was significant difference before and after surgery(P<0.05).Frankel classification of patients at the end of post operation was 1 cases,2 cases of grade B,2 cases of grade C,3 cases of D class,and 2 cases of E class.There were 2 cases of cerebrospinal fluid leakage during the perioperative period,1 cases of tuberculosis recurrence and 2 cases of wound healing.Conclusion Posterior spinal osteotomy and pedicle screw fixation,anterior column pad delayed treatment of spinal kyphosis and achieved good results,surgical trauma,less bleeding,fewer complications,wide application range,is a safe and effective surgical treatment method,delayed treatment of kyphosis is worthy of popularization and Application.