J Korean Soc Spine Surg.  2001 Sep;8(3):210-218. 10.4184/jkss.2001.8.3.210.

A Clinical Analysis of Surgical Treatment of Lumbar Degenerative Kyphosis

• Kim EH
• Han SK
• Kim HJ

• KMID: 2209737
• DOI: http://doi.org/10.4184/jkss.2001.8.3.210

Abstract

STUDY DESIGN: A retrospective study.
OBJECTIVES
To analyse associated preoperative conditions and postoperative causes of sagittal imbalance and to analyze clinical results of surgical treatment of lumbar degenerative kyphosis. SUMMARY OF LITERATURE REVIEW: There have been many controversies and high possibility of unsatisfactory results in surgical treatment of symptomatic degenerative lumbar kyphosis, which was complicated condition usually needed multi-level operation in old age.
MATERIALS AND METHODS
We analyzed 24 patients who complained of long standing stooping as one of main symptoms with radiologically measured lumbar kyphosis and underwent surgical restoration of lumbar lordodsis with long segmental spinal fusion from 1995 to 1999. Mean follow-up was 31.9months(from 24 to 48 months). Operative treatments were posterolateral fusion with pedicular screw(15 cases), anterior and posterior interbody fusion(5 cases), posterior interbody fusion with cage(1 case) and decancellation osteotomy(3 cases). Cases divided into 2 groups(Group A: improved stooping, Group B: recurred stooping) were evaluated by radiological measurement of changes in surgically restored lumbar lordosis correlated with clinical improvement of stooping. Overall clinical results were evaluated according to Kirkaldy-Willis criteria.
RESULTS
The associated conditions of preoperative lumbar kyphosis were recognized as multiple disc degeneration, segmental instability, degenerative vertebral wedging and pseudospondylolisthesis. Post-operative stooping recurred in 5 cases and caused by adjacent kyphosis in 2 cases, loss of correction in 1 case and both in 2 cases. Loss of correction was associated with pseudarthrosis in 1 case, screw loosening in 3 cases and allograft collapse in 2 cases. According to Kirkaldy-Willis, 8 cases of unsatisfactory clinical results consisted of 3 cases of pseudarthrosis out of 19 cases of Gruop A and all cases(5 cases) in group B. Most of correction loss occurred at lower lumbar spine(L3-S1) and was closely related to post-operative sagittal imbalance.
CONCLUSIONS
Maintenance of well corrected lumbar lordosis for sagittal balance and prevention of pseudarthrosis were mandatory for good clinical outcome in surgical treatment of lumbar degenerative kyphosis.

Keyword

Lumbar degenerative kyphosis; Sagittal imbalance; Pseudarthrosis; Surgical treatment

MeSH Terms

Allografts
Animals
Follow-Up Studies
Humans
Intervertebral Disc Degeneration
Kyphosis*
Lordosis
Pseudarthrosis
Retrospective Studies
Spinal Fusion

Figure

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  Fig. 1. Parameter which represent spinal alignment.

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  Fig. 2-A. Preoperative lateral radiography of 68-year-old man shows disc degeneration of L2-3 L3-4 L4-5 L5-S1, and rigid kyphosis in flexion-extension view. Fig. 2-B. Postoperative lateral radiography with L2-S1 posterolateral fusion with pedicular screw and pedicle subtraction osteotomy on L4 shows increased lumbar lordosis angle by 16˚. Postoperative 28-months followup lateral radiography of lumbar spine shows correction loss(L1-S1) by 8˚, but shows maintenance of lumbar lordosis and relief of stooping.

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  Fig. 3-A. Preoperative lateral radiography of 64-year-old woman shows disc degeneration of L4-5 L5-S1, wedge vertebrae L4 L5, and segmental instability L3-4 L4-5 in flexion-extension view. Fig. 3-B. Postoperative lateral radiography with L2-S1 posterolateral fusion with pedicular screws and L2-5 anterior interbody fusion with allograft shows increased lumbar lordosis angle by 15˚. Postoperative 33-months followup lateral radiography of lumbar spine shows compression fx L1 with correction loss(L1-S1) by 4˚, but showed maintenance of lumbar lordosis and relief of stooping.

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  Fig. 4-A. Preoperative lateral radiography of 66-year-old woman shows disc degeneration of L2-3 L4-5 L5-S1, wedge vertebrae L5 and pseudospondylolisthesis L3 on 4. Fig. 4-B. Postoperative lateral radiography with L2-S1 posterolateral fusion with pedicular screw and posterior lumbar interbody fusion with cage L4-5 shows increased lumbar lordosis angle by 11˚. Postoperative 33-months followup lateral radiography of lumbar spine shows correction loss(L1-S1) by 4˚, but showed maintenance of lumbar lordosis and relief of stooping.

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