EFFICACY OF MULTIPLE SMITH PETERSEN OSTEOTOMY IN ADULTS WITH THORACIC HYPERKYPHOSIS

TORASİK HİPERKİFOZU OLAN ERİŞKİNLERDE ÇOKLU SMİTH PETERSEN OSTEOTOMİSİNİN ETKİNLİĞİ

Abstract

Introduction: This is clinical study of adult patients with rigid hyperkyphosis, curve magnitude bigger than 70? who underwent with multiple Smith Petersen osteotomy and segmental pedicle screw. The aim of the study to show efficacy and safety of this surgical procedure for adult's hyperkyphosisMaterial and Method: Between 2011 and 2012, fifteen patients were operated for thoracic hyperkyphosis. Radiologic parameters were evaluated on standing long cassette anteroposterior (AP) and lateral columna vertebralis. We measured the thoracic and lumbar sagittal curve, pelvic incidence angle (PI), pelvic tilt (PT), sacral slope (SS), thoracic inlet alignment (TIA), T1 slope, relationship of the central sacral line (CSVL) preoperatively and at final follow-upResult: The mean 7 level SPO was performed in patients and 5,9? correction was obtained with each level osteotomy. Intraoperative mean bleeding was 980 ± 429 SD ml mean operative time was 342 ± 429 SD minutes. Patients were followed up for an average of 18,5 ± 5 SD months. The mean preoperative thoracic kyphosis was 79º ± 8,2 SD (70º-90º) and improved to 38º ± 8,3 SD (28º-42º) postoperatively and correction rate was 52% (range 39% to 62 %). Lumbar lordosis was 65º ± 3,3 SD (61º-69º) preoperatively and improved to 40º ± 2,4 SD (37º-43º) postoperatively. There were not significant differences between preoperative and postoperative spinopelvic values. T1 vertebra tilt was improved from 38º ± 2,9 SD to 29º ± 3,8 SD and TIA was improved from 80º ± 5,2 SD to 66º ± 3,1 SD. One dural tear was occurred and treated with suture and fibrin clothe.Conclusion: In this small series, using segmental pedicle screw and multiple SPO more than six level, overall correction of the thoracic kyphosis was 52 % and correction was 5,9? per one level osteotomy. SPO is effective and safe treatment method for adults with rigid deformity thoracic hyperkyphosis

Özet

Giriş: Bu çalışmada erişkinlerde görülen 70? den büyük rijit torakal hiperkifoz tedavisinde çoklu Smith petersen osteotomisi ve segmental pedikül vida ile tespitin etkinliği gösterilmesi amaçlanmıştır. Hastalar ve Yöntem: 2011 ve 2012 yılları arasında torakal hiperkifoz tanısı ile opere edilen 15 hasta bu çalışmaya alınmıştır. Radyolojik olarak ayakta çekilen AP ve LATERAL ortoröntgenogramlarda sagital torakolomber eğrilikler, pelvik insidans (PI),torasik inlet alignment (TIA),T1 slope, santral sakral düşey çizgi (CSVL) ameliyat öncesi ve kontrolleri karşılaştırıldı. Sonuçlar: Ortalama olarak 7 seviye SPO yapıldı. Her seviye için ortalama 5,9 ?lik düzeltme sağlandı. Peroperative ortalama kanama miktarı 980 ± 429 ml ve ortalama ameliyat süresi 342± 41 dakika olarak tespit edildi. Ortalama takip süresi 18,5 ± 5 aydı. Ortalama torakal hiperkifoz 79? ± 8,2? den (70? -90?) 38? ± 8,3? ye (28?-42?) geriledi. Lumbar lordoz 65? ± 3,3? den (61? -69?) 40 ? ± 2,4?ye (37? -43?) düştü. T1 vertebra tilt 38 ? ± 2,9? SD den 29 ? ± 3,8?ye ;TIA 80? ± 5,2 SD den 66? ± 3,1? ye geriledi. Bir hastada durameter yaralanması meydana geldi sütür ve fibrin yapıştırıcı ile tedavi edildi. Çıkarım: Çoklu SPO, rijit torakal hiperkifozun tedavisinde etkin ve güvenli tedavi metodu olarak kullanılabilir