J Korean Neurosurg Soc.  2022 Jan;65(1):64-73. 10.3340/jkns.2021.0069.

Partial Pedicle Subtraction Osteotomy for Patients with Thoracolumbar Fractures : Comparative Study between Burst Fracture and Posttraumatic Kyphosis

• Choi HY
• Jo DJ

• KMID: 2523914
• DOI: http://doi.org/10.3340/jkns.2021.0069

Abstract

Objective
: To evaluate the surgical outcomes of partial pedicle subtraction osteotomy (PPSO) in patients with thoracolumbar fractures and compare the outcomes of PPSO for burst fractures with those for posttraumatic kyphosis (PTK).
Methods
: From June 2013 to May 2019, 20 consecutive adult patients underwent PPSO for thoracolumbar fractures at the levels of T10 to L2. Of these patients, 10 underwent surgery for acute fractures (burst fractures), and 10 for sequelae of thoracolumbar fractures (PTK). Outcomes of PPSO were evaluated and compared between the groups.
Results
: Twenty patients (each 10 patients of burst fractures and PTK) with a mean age of 64.7±11.1 years were included. The mean follow-up period was 21.8±11.0 months. The mean correction of the thoracolumbar angle was -34.9°±18.1° (from 37.8°±20.5°preoperatively to 2.8°±15.2° postoperatively). The mean angular correction at the PPSO site was -38.4°±13.6° (from 35.5°±13.6° preoperatively to -2.9°±14.1° postoperatively). The mean preoperative sagittal vertical axis was 93.5±6.7 cm, which was improved to 37.6±35.0 cm postoperatively. The mean preoperative kyphotic angle at the PPSO site was significant greater in patients with PTK (44.8°±7.2°) than in patients with burst fractures (26.2°±12.2°, p=0.00). However, the mean postoperative PPSO angle did not differ between the two groups (-5.9°±15.7° in patients with burst fractures and 0.2°±12.4° in those with PTK, p=0.28). The mean angular correction at the PPSO site was significantly greater in patients with PTK (-44.6°±10.7°) than in those with burst fractures (-32.1°±13.7°, p=0.04). The mean operation time was 188.1±37.6 minutes, and the mean amount of surgical bleeding was 1030.0±533.2 mL. There were seven cases of perioperative complications occurred in five patients (25%), including one case (5%) of neurological deficit. The operation time, surgical bleeding, and complication rates did not differ between groups.
Conclusion
: In cases of burst fracture, PPSO provided enough spinal cord decompression without corpectomy and produced sagittal correction superior to that achieved with corpectomy. In case of PTK, PPSO achieved satisfactory curve correction comparable to that achieved with conventional PSO, with less surgical time, less blood loss, and lower complication rates. PPSO could be a viable surgical option for both burst fractures and PTK.

Keyword

Posttraumatic kyphosis; Spine trauma; Burst fracture; Spinal osteotomy

Figure

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  Fig. 1. Diagram of partial pedicle subtraction osteotomy. A : After removal of upper part of lamina, vertebral body is resected with wedgeshaped fashion (dotted line). Lower rim of pedicle is preserved. B : After closure of osteotomy site, thin pedicle bridge (dotted circle) and part of the posterior element remained intact, providing enhanced structural integrity and better fusion bed.

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  Fig. 2. Intraoperative photograph of partial pedicle subtraction osteotomy. A : Before closure of osteotomy site, spinal canal decompression is verified. Note that lower lamina of index vertebra remained intact (arrows). B : Complete closure of posterior element is achieved after closure of osteotomy site.

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  Fig. 3. A : A 60-year-old man presented with complete paraplegia after falling from fourstory building. Initial X-ray revealed L1 burst fracture with kyphotic deformity (26.0°). B : Postoperative X-ray at 3 months showed correction of local kyphosis to -14.0°. Note the remained thin pedicle after partial pedicle subrtraction osteotomy (arrow). C : Solid fusion was achieved at the last follow-up (postoperative 2 years) without loss of correction. D and E : Preoperative and posteoperative computed tomography showed removal of retropulsed fragment and decompression of spinal canal.

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  Fig. 4. A : A 58-year-old woman presented with 10-year history of persistent pain on back and lower extremities after slip down. She also complained of progressive stooped posture on walking. Preoperative X-ray showed posttraumatic kyphosis at L1 (46.1°). B : Postoperative X-ray at 3 months showed improvement of kyphotic deformity (5.0°) with good sagittal alignment. C : Postoperavie X-ray at the last follow-up (postoperative 1 year) did not show loss of correction or junctional kyphosis. D : Preoperative computed tomography (CT) showed kyphotic deformity due to old trauma. E : Postoperative CT showed solid arthrodesis of osteotomized vertebra with part of intact posterior element (arrow).

Reference

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