• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.84-95
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• 2022

Objective : To investigate the clinical efficacy and safety of the controlled distraction-compression technique using an expandable titanium cage (ETC) in posttraumatic kyphosis (PTK). Methods : We retrospectively studied and collected data on 20 patients with PTK. From January 2014 to December 2017, the controlled distraction-compression technique using ETC was consecutively performed in 20 patients with PTK of the thoracolumbar zone (range, 36-82 years). Among them, nine were males and 11 were females and the mean age was 61.5 years. The patients were followed regularly at 1, 3, 6, and 12 months, and the last follow-up was more than 2 years after surgery. Results : The mean follow-up period was 27.3±7.3 months (range, 14-48). The average operation time was 286.8±33.1 minutes (range, 225-365). The preoperative regional kyphotic angle (RKA) ranged from 35.6° to 70.6° with an average of 47.5°±8.1°. The immediate postoperative mean RKA was 5.9°±3.8° (86.2% correction rate, p=0.000), and at the last follow-up more than 2 years later, the mean RKA was 9.2°±4.9° (80.2% correction rate, p=0.000). The preoperative mean thoracolumbar kyphosis was 49.1°±9.2° and was corrected to an average of 8.8°±5.3° immediately after surgery (p=0.000). At the last follow-up, a correction of 11.9°±6.3° was obtained (p=0.000). The preoperative mean back visual analog scale (VAS) score was 7.9±0.8 and at the last follow-up, the VAS score was improved to a mean of 2.3±1.0 with a 70.9% correction rate (p=0.000). The preoperative mean Oswestry disability index (ODI) score was 32.3±6.9 (64.6%) and the last follow-up ODI score was improved to a mean of 6.85±2.9 (3.7%) with a 78.8% correction rate (p=0.000). The overall complication was 15%, with two of distal junctional fractures and one of proximal junctional kyphosis and screw loosening. However, there were no complications directly related to the operation. Conclusion : Posterior vertebral column resection through the controlled distraction-compression technique using ETC showed safe and good results in terms of complications, and clinical and radiologic outcomes in PTK. However, to further evaluate the efficacy of this surgical procedure, more patients need long-term follow-up and there is a need to apply it to other diseases.

• Journal of Korean Neurosurgical Society
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• v.65 no.1
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• pp.64-73
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• 2022

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.

• Journal of Korean Neurosurgical Society
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• v.61 no.1
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• pp.1-9
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• 2018

Posttraumatic delayed vertebral collapse, known as Kummell's disease, is increasing in number of patients. This disease is already progressive kyphosis due to vertebral collapse at the time of diagnosis and it causes intractable pain or neurologic deficit due to intravertebral instability. Treatment is very difficult after progression of the disease, and the range of treatment, in hospital day, and cost of treatment are both increased. Clinical features, pathogenesis and radiologic findings of these disease groups were reviewed to determine risk factors for delayed vertebral collapse. The purpose of this article is to suggest appropriate treatment before vertebral collapse for patients with osteoporotic vertebral compression fracture who have risk factors for posttraumatic delayed vertebral collapse.

• Journal of Korean Neurosurgical Society
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• v.29 no.6
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• pp.763-771
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• 2000

Objectives : Thoracolumbar burst fractures(TBLF) result in not only compressive deformity of vertebral body but also spinal cord compression by bony fragments. Many thoracolumbar burst fractures demand both anterior decompression and intervertebral fusion. Most of spinal surgeons use anterior instrumentation for anteior intervertebral bony fusion. The use of Z-plate has been increased recently, however there has been only a few reports regarding its clinical long-term strength. We studied nineteen patients with TBLF to find out the long-term stability of Z-plate. Methods : We have operated 19 patients from March 1996 to August 1998. They were treated with anterior decompression through either a transthoracic, retroperitoneal extrapleural or retroperitoneal approach. Retropulsed bony fragments were removed completely by corpectomy. Iliac bone graft was used for interbody fusion in all of the cases. They were evaluated by plain X-ray films including flexion and extention lateral films. Cobbs angle was used to evaluate kyphotic and lateral wedging deformity. Results : Burst fractured sites were T11 in two, three T12, nine L1, and five L2. Mean follow-up duration was fifteen months. Preoperative average kyphotic angle was 23.7 degree. Immediate postoperative kyphotic angle was 10.2 degree. Follow-up resluts of average kyphotic angles revealed 14 degrees. Four patients(21%), including two spinal 3-column injury, showed increasement of kyphotic angle more than 5 degree or breakage of intrumentation. Two patients showed the difference of kyphotic angle more than 3 degree. Five patients(26%) revealed lateral wedging deformity more than 3 degrees. Postoperative complications were two meralgia parestheticas, one pulmonary atelectasis and two donor site infections. Four of the eight patients, who initially showed incomplete spinal cord deficits, were nerologically improved by Frankel's grade. Conclusion : Z-plate fixation and iliac bone graft after anterior decompression in thoracolumbar burst fractures is a safe and easy method. Immediate postoperative results revealed excellent correction of posttraumatic kyphosis, but long-term follow-up evalution showed insufficient strength. Therefore we believe that use of Z-plate should be carefully decided, especially in the case of large lumbar fracture or 3-column injury.