Surgical Treatment of Post-Traumatic Kyphosis with Neurologic Compromised Osteoporotic Fracture: Comparison between Anterior-Posterior Surgery versus Posterior Egg-Shell Procedure.
10.4184/jkss.2002.9.2.148
- Author:
Se Il SUK
1
;
Jin Hyok KIM
;
Ewy Ryong CHUNG
;
Sang Min LEE
;
Jung Hee LEE
;
Sung Soo KIM
;
Sung Wook WON
;
Soo Chul PARK
;
Rack Yong CHUNG
Author Information
1. Seoul Spine Institute, Inje University Sanggye Paik Hospital, Korea. dragon@sanggyepaik.ac.kr
- Publication Type:Original Article
- Keywords:
Post-traumatic kyphosis;
Egg-Shell procedure;
Osteoporosis;
Neurologic deficit
- MeSH:
Aged;
Braces;
Congenital Abnormalities;
Female;
Follow-Up Studies;
Humans;
Kyphosis*;
Male;
Neurologic Manifestations;
Operative Time;
Osteoporosis;
Osteoporotic Fractures*;
Pneumonia;
Retrospective Studies
- From:Journal of Korean Society of Spine Surgery
2002;9(2):148-156
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
STUDY DESIGN: Retrospective study. OBJECTIVES: To compare the surgical results between anterior-posterior surgery and posterior eggshell procedures in post-traumatic kyphosis with neurologic compromised osteoporotic fracture. SUMMARY OF LITERATURE REVIEW: Combined anterior-posterior surgery is usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, it is associated with significant morbidity in elderly patients. MATERIALS AND METHODS: Twenty-six post-traumatic kyphosis with neurologic compromised osteoporotic fracture patients subjected to either anterior-posterior surgery (n=11) or posterior egg-shell procedure (n=15) were analyzed. The average age at the operation was 62.6 years (range: 50-82), male : female ratio was 12 : 14, and the average follow up was 2.9 years (range:2.0-4.9). Preoperative interval from injury to operation was 15.4 months (range: 1-36). Thoracolumbar (T12-L1) fracture was in 20 and lumbar fracture was in 6. RESULTS: There was no significant difference in age, sex, preoperative and postoperative Frankel grade, and preoperative vertebral collapse between two groups(p<0.05). In anterior-posterior group, the mean operation time was 351 minutes with a mean blood loss of 2892 ml, and preoperative kyphosis of 22 degrees was corrected to 11 degrees at latest follow-up with 7 cases of neurologic improvement. In the eggshell group, the mean operative time was 215 minutes with blood loss of 1930 ml, and preoperative kyphosis of 34 degrees was corrected to 8 degrees at latest follow-up with 11 cases of neurologic improvement. Egg-shell group showed significantly less operation time and blood loss with beter kyphosis correction. In anterior-posterior group, postoperative pneumonia was developed in 2 and superficial infection in 1. Distal screw loosening was detected in 4, 2 in anterior-posterior group and 2 in posterior eggshell group. One of them was treated by revision and others were treated by brace more than 6 months. CONCLUSIONS: Posterior eggshell procedure showed a better kyphosis correction with significantly less operation time and blood loss. It is a preferable alternative to anterior-posterior surgery in post-traumatic kyphosis with neurologic compromised osteoporotic fracture.
