Apical lordosating osteotomy and minimal segment fixation for the treatment of thoracic or thoracolumbar osteoporotic kyphosis

Study Design. Retrospective review. Objective. To assess the effectiveness of apical lordo-sating osteotomy (ALO) and minimal segment fixation through a posterior approach for correcting thoracic or thoracolumbar osteoporotic kyphosis (OK). Summary of Background Data. Current surgical options for OK involve a risk of complex surgery in elderly patients, graft problems (e. g., graft dislodgement, subsidence, pseudarthrosis), and instrumentation problems (e. g., adjacent-segment failure, implant pullout). A posterior-only approach was used to make the surgery less invasive and safer. Methods. A total of 26 consecutive patients (average age 71.5 years, range 65-81) with thoracic or thoracolumbar OK underwent ALO. Mean follow-up was 3.2 years (range 2.1-6.1). Radiographic studies, complications, and patient satisfaction were assessed. Results. Mean operating time was 137 minutes, and mean blood loss was 717 mL. In 8 patients with thoracic hyperkyphosis, mean Cobb angle was corrected from 82.7 degrees (range 75 degrees-97 degrees) to 25.8 degrees (range 18 degrees-30 degrees), indicating normal kyphosis. In 18 patients, thoracolumbar kyphosis of 56.3 degrees (range 47 degrees-71 degrees) was corrected to -1.8 degrees (range -11 degrees to 7 degrees). Sagittal imbalance was 12.1 cm before surgery and 4.9 cm afterward. Satisfactory correction was achieved in all patients, without anterior release. Local kyphosis was corrected to -9.1 degrees from 53.6 degrees, and mean vertebral kyphosis to -26.6 degrees from 17.7 degrees. In 17 patients with neurologic deficit, Frankel grades improved after surgery. No major complication occurred. All patients had improved pain, self-image, and overall satisfaction. Conclusions. ALO and minimal segments fixation appear to hold promise for the treatment of thoracic or thoracolumbar OK, and may be safer with fewer complications. A larger series with more patients and surgeons is needed for confirmation.