Comparison of posterior vertebral column resection and anterior corpectomy and instrumentation for correcting late post-traumatic thoracolumbar kyphosis

Purpose: To compare the clinical and radiological outcomes between anterior corpectomy & instrumentation (ACI) and posterior vertebral column resection (PVCR) in correcting late post-traumatic kyphosis (LPTK) of the thoracolumbar spine. Methods: Between January 2007 and December 2012, twenty patients underwent ACI, and twenty-three patients underwent PVCR for LPTK were prospectively reviewed. The clinical records were reviewed and compared for surgical time, blood loss, functional improvement (Oswestry Disability Index, ODI), pain relief (Visual Analog Scale, VAS). The radiological records were reviewed and compared for correction of kyphotic deformity, correction loss, fusion rate, cage subsidence and cage tilting. Results: The surgery time was shorter in PVCR group than that in ACI group (156.3 ± 32.9 min vs. 188.3 ± 37.1 min, P=0.006), the blood loss was less in PVCR group than that in ACI group (806.5 ± 174.5 ml vs. 974.5 ± 146.1 ml, P=0.021), the difference of deformity correction was statistically significant in favor of the PVCR group (37.3 ± 5.2 vs. 22.3 ± 4.4, P<0.001). At 24 months follow-up, no statistical difference was found between the two groups in cage subsidence (2.1 ± 0.7 mm in PVCR vs. 1.9 ± 0.8 mm in ACI, P=0.796), anterior-posterior cage tilting (2.0 ± 0.5 in PVCR vs. 2.4 ± 0.7 in ACI, P=0.111), lateral cage tilting (2.9 ± 0.8 in PVCR vs. 3.2 ± 0.9 in ACI, P=0.342) and correction loss (2.8 ± 1.8 in PVCR vs. 2.5 ± 1.7 in ACI, P=0.536). All of the patients got ODI improvement and VAS relief, and no statistical difference was found between the two groups in ODI improvement (44.2 ± 5.7% in PVCR vs. 42.9 ± 5.9% in ACI, P=0.444) and VAS relief (5.2 ± 0.9 in PVCR vs. 5.3 ± 1.3 in ACI, P=0.815). Conclusions: The posterior vertebral column resection have the advantage over anterior corpectomy & instrumentation in shorter surgery time, less blood loss, and more kyphotic correction for correcting late post-traumatic kyphosis of the thoracolumbar spine.

[1]  F. Pellisé,et al.  Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year? , 2016, European Spine Journal.

[2]  Xuhui Zhou,et al.  Modified partial pedicle subtraction osteotomy for the correction of post-traumatic thoracolumbar kyphosis. , 2015, The spine journal : official journal of the North American Spine Society.

[3]  Eun-Min Seo,et al.  Clinical and radiological outcomes of modified posterior closing wedge osteotomy for the treatment of posttraumatic thoracolumbar kyphosis. , 2015, Journal of neurosurgery. Spine.

[4]  W. Ding,et al.  Unilateral posterior vertebral column resection for severe thoracolumbar kyphotic deformity caused by old compressive vertebrae fracture: a technical improvement. , 2015, International journal of clinical and experimental medicine.

[5]  Zhongqiang Chen,et al.  Posterior Surgical Correction of Posttraumatic Kyphosis of the Thoracolumbar Segment , 2013, Journal of spinal disorders & techniques.

[6]  J. Mac-Thiong,et al.  Treatment of Thoracolumbar Burst Fractures by Means of Anterior Fusion and Cage , 2012, Journal of spinal disorders & techniques.

[7]  Tao Zhang,et al.  Anterior Z-Plate and Titanic Mesh Fixation for Acute Burst Thoracolumbar Fracture , 2011, Spine.

[8]  G. Said,et al.  Comparison between pedicle subtraction osteotomy and anterior corpectomy and plating for correcting post-traumatic kyphosis: a multicenter study , 2011, European Spine Journal.

[9]  M. Fehlings,et al.  Posttraumatic Kyphosis: Current State of Diagnosis and Treatment: Results of a Multinational Survey of Spine Trauma Surgeons , 2010, Journal of spinal disorders & techniques.

[10]  Z. Wang,et al.  Correction of severe post-traumatic kyphosis by posterior vertebra column resection. , 2010, Chinese medical journal.

[11]  D. Chou,et al.  Pedicle subtraction osteotomies for the correction of post-traumatic thoracolumbar kyphosis , 2010, Journal of Clinical Neuroscience.

[12]  E. Munting.  Surgical treatment of post-traumatic kyphosis in the thoracolumbar spine: indications and technical aspects , 2010, European Spine Journal.

[13]  M. Sasani,et al.  Single-Stage Posterior Corpectomy and Expandable Cage Placement for Treatment of Thoracic or Lumbar Burst Fractures , 2009, Spine.

[14]  A. Kaya,et al.  Minimum 5-Year Follow-up Surgical Results of Post-traumatic Thoracic and Lumbar Kyphosis Treated With Anterior Instrumentation: Comparison of Anterior Plate and Dual Rod Systems , 2007, Spine.

[15]  J. Torner,et al.  Comparison of anterolateral and posterior approaches in the management of thoracolumbar burst fractures. , 2006, Journal of neurosurgery. Spine.

[16]  R. Poolman,et al.  Clinical outcome and radiographic results after surgical treatment of post-traumatic thoracolumbar kyphosis following simple type A fractures , 2004, European Spine Journal.

[17]  Jung-Hee Lee,et al.  Anterior-Posterior Surgery Versus Posterior Closing Wedge Osteotomy in Posttraumatic Kyphosis With Neurologic Compromised Osteoporotic Fracture , 2003, Spine.

[18]  L. Lenke,et al.  Anterior Fresh Frozen Structural Allografts in the Thoracic and Lumbar Spine: Do They Work If Combined With Posterior Fusion and Instrumentation in Adult Patients With Kyphosis or Anterior Column Defects? , 1995, Spine.