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Anterior-posterior surgery versus posterior closing wedge osteotomy in posttraumatic kyphosis with neurologic compromised osteoporotic fracture

STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between combined anterior-posterior procedures and posterior closing wedge osteotomy procedures in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures. SUMMARY OF BACKGROUND DATA: Combined anterior-posterior procedures are usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, combined anterior-posterior surgery is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture were indicated for operative intervention using either a combined anterior-posterior surgery (n = 11) or a posterior closing wedge osteotomy procedure (n = 15). The results of the two procedures were analyzed. The average patient age at the operation was 62.6 years (range: 50-82) with a 12:14 male-to-female ratio. Mean follow-up was 3.5 years (range: 2.1-5.4). Preoperative interval from injury to operation was 15.4 months (range: 1-36). There were 20 thoracolumbar (T12-L1) fractures and six lumbar fractures indicated for operative intervention. RESULTS: In the combined anterior-posterior group, the mean operative time was 351 minutes with a mean blood loss of 2,892 mL. In the posterior closing wedge osteotomy group, the mean operative time was 215 minutes with blood loss of 1,930 mL. Eighteen patients showed a postoperative improvement in Frankel grading, 64% (7/11) in the combined anterior-posterior group, and 73% (11/15) in posterior closing wedge osteotomy group. There were no neurologic or vascular complications in either group. In the combined anterior-posterior group, there were five complications: two postoperative pneumonias, one superficial infection, and two distal screw loosening. There were only two complications in the posterior closing wedge osteotomy group: two distal screw loosening. One of the four cases of distal screw loosening required surgical revision. The other three cases were treated by bracing for more than 6 months. CONCLUSIONS: Although technically demanding, the posterior closing wedge osteotomy procedure demonstrated a better surgical result with significant less mean operative time and mean blood loss (P < 0.05). It may be a better alternative than a combined anterior-posterior procedure in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture Keywords : Accidental Falls,Accidents,Traffic,Aged,Aged,80 and over,blood,Blood Loss,Surgical,Bone Screws,Bone Transplantation,Braces,complications,diagnostic imaging,epidemiology,Equipment Failure,etiology,Female,Follow-Up Studies,Fracture Fixation,Internal,Fractures,Compression,Fractures,Spontaneous,Humans,Infection,injuries,instrumentation,Internal Fixators,Kyphosis,Lumbar Vertebrae,Male,methods,Middle Aged,Morbidity,Osteoporosis,Osteoporotic Fractures,Osteotomy,Patients,Pneumonia,Postoperative Complications,Radiography,Retrospective Studies,secondary,Spinal Cord Compression,Spinal Fractures,Spinal Fusion,Spine,surgery,Surgical Mesh,therapy,Thoracic Vertebrae,Time,, Surgery,Versus,Posterior,Closing,Wedge, botox leg injections side effects

Date of Publication : 2003 Sep 15

Authors : Suk SI;Kim JH;Lee SM;Chung ER;Lee JH;

Organisation : Seoul Spine Institute, Inje University Sanggye Paik Hospital, Seoul, Korea. seilsuk@unitel.co.kr

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/14501932

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