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 complication. 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 or 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 when compared with preoperative ones, 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 in above indexes 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.
Objective To compare the effectiveness of anterior intervertebral osteotomy and fusion (AIOF), utilizing the inflection point of the uncinate process (IPUP) as an auxiliary positioning landmark, versus conventional anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy (CSM). Methods A retrospective analysis was conducted on the clinical data of 60 patients with CSM who met the selection criteria and were admitted between June 2021 and December 2024. Among them, 32 patients underwent AIOF using the IPUP as an auxiliary positioning landmark (AIOF group), and 28 patients underwent ACDF (ACDF group). Baseline characteristics—including gender, age, surgical segments, preoperative visual analogue scale (VAS) score for pain, Japanese Orthopaedic Association (JOA) score, cervical lordosis angle, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments—showed no significant difference between the two groups (P>0.05). Operation time, intraoperative blood loss, and the incidence of complications were recorded for both groups. Functional recovery and pain relief were evaluated using JOA and VAS scores preoperatively, at 3 months postoperatively, and at last follow-up. The cervical lordosis angle (C2-C7 Cobb angle) and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments were also measured. Interbody fusion and Cage subsidence rates were assessed at last follow-up. Results Operations were successfully completed in all patients, with no significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). Postoperative dysphagia occurred in 2 cases (6.3%) in the AIOF group and 3 cases (10.7%) in the ACDF group, showing no significant difference (P>0.05). Neither group experienced complications such as hoarseness, cerebrospinal fluid leakage, dural tear, spinal cord injury, choking on water, or C5 nerve root palsy. All patients completed the follow-up, with the follow-up durations of (14.6±2.3) months in the AIOF group and (15.1±2.1) months in the ACDF group, showing no significant difference (t=0.852, P=0.398). No loosening or breakage of internal fixator was observed during follow-up, and complete bony fusion was achieved in all surgical segments. At last follow-up, no Cage subsidence occurred in either group. At 3 months postoperatively and at last follow-up, JOA scores, VAS scores, cervical lordosis angles, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments significantly improved when compared with preoperative values in both groups (P<0.05). Except for the cervical lordosis angle, which showed no significant difference between the two groups (P>0.05), the AIOF group demonstrated superior outcomes compared to the ACDF group in JOA score, VAS score, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments (P<0.05). Conclusion AIOF using the IPUP as an auxiliary positioning landmark provides satisfactory effectiveness in treating CSM. It is superior to traditional ACDF in improving neurological function, relieving pain, and restoring spinal cord morphology without increasing the risk of complications, representing a safe and effective surgical procedure.