[Effects of Scoliosis Research Society-Schwab grade Ⅳ osteotomy for post-traumatic thoracolumbar kyphosis]

Objective: To evaluate the effectiveness of Scoliosis Research Society (SRS)-Schwab grade Ⅳ osteotomy in the treatment of post-traumatic thoracolumbar kyphosis (PTK). Methods: From October 2012 to January 2015, a total of 31 patients [12 males, 19 females, mean age (43±10) years] with symptomatic PTK undergoing SRS-Schwab grade Ⅳ osteotomy in Nanjing Drum Tower Hospital were retrospectively reviewed.Radiographic changes were evaluated with preoperative, postoperative and follow-up X-ray.The measurements included thoracic kyphosis (TK), lumbar lordosis (LL), thoracolumbar kyphosis (TLK), focal kyphosis (FK), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS) and sagittal vertical axis (SVA). Clinical outcome was assessed using the visual analogue scale (VAS), the Oswestry disability index (ODI) and Frankel neurological grade before surgery and during follow-up.The preoperative, postoperative and follow-up data were compared with paired t test. Results: All patients were followed-up for 28±5 months (24-38 months). The TK and LL improved significantly postoperatively from 15.6°±7.8° and 67.3°±12.2° to 28.1°±6.2° and 48.1°±9.3°(t=-6.985, 6.968, both P<0.05), and maintained at 27.3°±6.9° and 49.4°±7.9° at last follow-up, respectively.The TLK and FK improved significantly postoperatively from 29.4°±12.2° and 36.4°±9.5° to 7.7°±5.3° and 5.6°±4.2°(t=9.083, 16.510, both P<0.05), with a correction loss of 2.4°±2.0° and 2.3°±2.2° at final follow-up, respectively.No significant difference was observed in the PI, PT, SS and SVA among preoperative, post-operative and the last follow-up data.In addition, the VAS and ODI improved significantly at the final follow-up.Four cases with Frankel D experienced complete neurological recovery at the final follow-up.Radiographic evaluation showed solid bony fusion.No instrument-related complication was observed during the follow up. Conclusions: The SRS-Schwab grade Ⅳ osteotomy brings satisfactory sagittal alignment and good clinical outcomes in patients with PTK.