Effectiveness of posterior single-level osteotomy with 360° release and correction in treatment of osteoporotic vertebral compression fractures with moderate to severe kyphosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 QING Peidong , XU Hongda , HU Youpeng , XIE Bin , WANG Tieheng , ZHANG Lei

Department of Spinal Surgery, Mianyang Orthopedic Hospital, Mianyang Sichuan, 621000, P. R. China;

Corresponding?author：

QING Peidong, Email: qingpeidong@163.com

Keywords：

Osteoporotic vertebral compression fractures; moderate to severe kyphosis; intervertebral osteotomy; Cage

DOI：

10.7507/1002-1892.202509073

Video：

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Objective To explore the effectiveness of posterior single-level osteotomy with 360° release and correction for the treatment of osteoporotic vertebral compression fractures (OVCF) complicated with moderate to severe kyphosis. Methods A retrospective analysis was conducted on 11 patients with OVCF complicated with moderate to severe kyphosis between January 2022 and March 2023. There were 4 males and 7 females with an average age of 57 years ranging from 47 to 69 years. The disease duration ranged from 3 to 15 months, with an average of 7 months. Fracture segments included T₁₁ in 3 cases, T₁₂ in 5, L₁ in 2, and L₂ in 1. The T value of lumbar spine bone density was ?5.0 to ?2.0, with an average of ?3.5. The preoperative neurological function was grade E according to Frankel grading. The Pfirrmann classification of the intervertebral disc above the injured vertebra was grade Ⅲ in 8 cases and grade Ⅳ in 3 cases. All patients underwent posterior single-level osteotomy with 360° release and correction. The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded. Thoracolumbar local kyphosis Cobb angle, the mean height of the functional spinal unit (FSU), the sagittal vertical axis (SVA), and the sagittal index (SI) were measured. The visual analogue scale (VAS) score and Oswestry disability index (ODI) were used to evaluate the improvement of pain and function before operation, at 1 month after operation, and at last follow-up. Results The operation successfully completed in all patients, and there was no obvious complications. The operation time ranged from 100 to 190 minutes, with an average of 153 minutes, and the intraoperative blood loss ranged from 200 to 800 mL, with an average of 468 mL. The length of hospital stay was 8-14 days (mean, 12 days). All patients were followed up 6-24 months, with an average of 12.4 months. At last follow-up, all the 11 patients had bony fusion in the osteotomy area, and there was no displacement or subsidence of the Cage, no complication such as internal fixation failure and pseudarthrosis formation was found. The Cobb angle of local thoracolumbar kyphosis, the mean height of FSU, SVA, and SI significantly improved immediately after operation and at last follow-up, and the VAS score and ODI also significantly improved at 1 month after operation and at last follow-up (P<0.05); there was no significant difference between the two time points after operation (P>0.05). Conclusion Posterior single-level osteotomy with 360° release and correction is an effective surgical method for treating OVCF complicated with moderate to severe kyphosis, with definite early effectiveness.

1.	秦杰, 蘇保, 王霖邦, 等. 經椎弓根下椎體椎間隙截骨術治療陳舊性骨質疏松性椎體壓縮骨折繼發胸腰段后凸畸形. 中國修復重建外科雜志, 2022, 36(3): 305-309.
2.	Wang Y, Zhu W, Sun K, et al. Selecting proper distal fusion level in severe thoracolumbar kyphosis secondary to late osteoporotic vertebral compression fracture to limit distal complications. J Orthop Sci, 2022, 27(6): 1177-1184.
3.	陳建, 李青青, 顧軍, 等. 老年骨質疏松性胸腰段椎體骨折伴后凸畸形診療指南(2024版). 中華創傷雜志, 2024, 40(11): 961-973.
4.	Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
5.	徐寶山, 黎寧, 許海委, 等. 胸腰椎骨質疏松性椎體壓縮骨折伴后凸畸形的分級手術策略. 中華骨科雜志, 2023, 43(11): 677-686.
6.	Okuda S, Oda T, Yamasaki R, et al. Surgical outcomes of osteoporotic vertebral collapse: a retrospective study of anterior spinal fusion and pedicle subtraction osteotomy. Global Spine J, 2012, 2(4): 221-226.
7.	張家豪, 袁磊, 劉寅昊, 等. 陳舊性骨質疏松性椎體壓縮骨折繼發胸腰椎后凸畸形的開放性手術治療進展. 中華骨科雜志, 2023, 43(7): 465-470.
8.	Xu Z, Hao D, Dong L, et al. Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases. BMC Surg, 2021, 21(1): 22. doi: 10.1186/s12893-020-01013-1.
9.	姜宇, 郭昭慶, 陳仲強, 等. 陳舊性骨質疏松椎體壓縮骨折繼發胸腰椎后凸畸形的手術治療. 中華骨科雜志, 2023, 43(7): 1249-1253.
10.	張銀昌, 趙清華, 秦曉東, 等. SRS-Schwab Ⅳ級截骨聯合衛星棒技術治療胸腰椎陳舊性骨質疏松性骨折伴嚴重后凸畸形. 中國修復重建外科雜志, 2019, 33(3): 259-264.
11.	Yaman O, Zileli M, Sharif S. Decompression and fusion surgery for osteoporotic vertebral fractures: WFNS spine committee recommendations. J Neurosurg Sci, 2022, 66(4): 327-334.
12.	Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
13.	Wang HW, Hu YC, Wu ZY, et al. One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporotic vertebral compression fractures. Orthop Surg, 2021, 13(3): 908-919.
14.	Kim SK, Chung JY, Park YJ, et al. Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures. Orthop Surg, 2020, 12(2): 388-395.
15.	周建偉, 馬玉泉, 王飛, 等. 后路經椎弓根截骨前柱重建治療陳舊性骨質疏松性椎體壓縮骨折的臨床研究. 中國修復重建外科雜志, 2016, 30(5): 575-579.
16.	Li J, Zhang J, Xian S, et al. Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures: a retrospective study of 104 patients. Eur Spine J, 2024, 33(8): 3275-3283.
17.	Hyun SJ, Lenke LG, Kim YC, et al. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976), 2014, 39(22): 1899-1904.
18.	樓宇梁, 全仁夫, 李偉, 等. 陳舊性胸腰椎骨質疏松性骨折伴后凸畸形手術截骨方式的選擇. 中國骨傷, 2020, 33(5): 459-464.
19.	Li Q, Chen X, Shi H. Comparison of corrective and clinical effects between SRS-Schwab grade Ⅳ osteotomy combined with the interbody fusion cage and pure grade Ⅳ osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis. Ann Palliat Med, 2022, 11(1): 272-280.

1. 秦杰, 蘇保, 王霖邦, 等. 經椎弓根下椎體椎間隙截骨術治療陳舊性骨質疏松性椎體壓縮骨折繼發胸腰段后凸畸形. 中國修復重建外科雜志, 2022, 36(3): 305-309.
2. Wang Y, Zhu W, Sun K, et al. Selecting proper distal fusion level in severe thoracolumbar kyphosis secondary to late osteoporotic vertebral compression fracture to limit distal complications. J Orthop Sci, 2022, 27(6): 1177-1184.
3. 陳建, 李青青, 顧軍, 等. 老年骨質疏松性胸腰段椎體骨折伴后凸畸形診療指南(2024版). 中華創傷雜志, 2024, 40(11): 961-973.
4. Schwab F, Blondel B, Chay E, et al. The comprehensive anatomical spinal osteotomy classification. Neurosurgery, 2014, 74(1): 112-120.
5. 徐寶山, 黎寧, 許海委, 等. 胸腰椎骨質疏松性椎體壓縮骨折伴后凸畸形的分級手術策略. 中華骨科雜志, 2023, 43(11): 677-686.
6. Okuda S, Oda T, Yamasaki R, et al. Surgical outcomes of osteoporotic vertebral collapse: a retrospective study of anterior spinal fusion and pedicle subtraction osteotomy. Global Spine J, 2012, 2(4): 221-226.
7. 張家豪, 袁磊, 劉寅昊, 等. 陳舊性骨質疏松性椎體壓縮骨折繼發胸腰椎后凸畸形的開放性手術治療進展. 中華骨科雜志, 2023, 43(7): 465-470.
8. Xu Z, Hao D, Dong L, et al. Surgical options for symptomatic old osteoporotic vertebral compression fractures: a retrospective study of 238 cases. BMC Surg, 2021, 21(1): 22. doi: 10.1186/s12893-020-01013-1.
9. 姜宇, 郭昭慶, 陳仲強, 等. 陳舊性骨質疏松椎體壓縮骨折繼發胸腰椎后凸畸形的手術治療. 中華骨科雜志, 2023, 43(7): 1249-1253.
10. 張銀昌, 趙清華, 秦曉東, 等. SRS-Schwab Ⅳ級截骨聯合衛星棒技術治療胸腰椎陳舊性骨質疏松性骨折伴嚴重后凸畸形. 中國修復重建外科雜志, 2019, 33(3): 259-264.
11. Yaman O, Zileli M, Sharif S. Decompression and fusion surgery for osteoporotic vertebral fractures: WFNS spine committee recommendations. J Neurosurg Sci, 2022, 66(4): 327-334.
12. Kanayama M, Ishida T, Hashimoto T, et al. Role of major spine surgery using Kaneda anterior instrumentation for osteoporotic vertebral collapse. J Spinal Disord Tech, 2010, 23(1): 53-56.
13. Wang HW, Hu YC, Wu ZY, et al. One approach anterior decompression and fixation with posterior unilateral pedicle screw fixation for thoracolumbar osteoporotic vertebral compression fractures. Orthop Surg, 2021, 13(3): 908-919.
14. Kim SK, Chung JY, Park YJ, et al. Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures. Orthop Surg, 2020, 12(2): 388-395.
15. 周建偉, 馬玉泉, 王飛, 等. 后路經椎弓根截骨前柱重建治療陳舊性骨質疏松性椎體壓縮骨折的臨床研究. 中國修復重建外科雜志, 2016, 30(5): 575-579.
16. Li J, Zhang J, Xian S, et al. Modified pedicle subtraction osteotomy for osteoporotic vertebral compression fractures: a retrospective study of 104 patients. Eur Spine J, 2024, 33(8): 3275-3283.
17. Hyun SJ, Lenke LG, Kim YC, et al. Comparison of standard 2-rod constructs to multiple-rod constructs for fixation across 3-column spinal osteotomies. Spine (Phila Pa 1976), 2014, 39(22): 1899-1904.
18. 樓宇梁, 全仁夫, 李偉, 等. 陳舊性胸腰椎骨質疏松性骨折伴后凸畸形手術截骨方式的選擇. 中國骨傷, 2020, 33(5): 459-464.
19. Li Q, Chen X, Shi H. Comparison of corrective and clinical effects between SRS-Schwab grade Ⅳ osteotomy combined with the interbody fusion cage and pure grade Ⅳ osteotomy in the treatment of old thoracolumbar vertebral osteoporotic fractures with kyphosis. Ann Palliat Med, 2022, 11(1): 272-280.

Chinese Journal of Reparative and Reconstructive Surgery

Latest ArticlesEffectiveness of posterior single-level osteotomy with 360° release and correction in treatment of osteoporotic vertebral compression fractures with moderate to severe kyphosis

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