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KMID : 0388720220290020017
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Journal of Korean Society of Spine Surgery
2022 Volume.29 No. 2 p.17 ~ p.26
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Comparative Analysis of Surgical Decompression and Fusion Methods for the Treatment of Thoracic Myelopathy: Posterior Vertebral Column Resection, Anterior and Posterior Decompression, and Posterior Decompression without Column Resection
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Kim Sung-Soo
Choi Byung-Wan
Kwon Yu-Seung
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Abstract
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Study Design: Retrospective case analysis.
Objectives: To compare three decompression and fusion methods?posterior vertebral column resection (PVCR), anterior and posterior (AP) decompression, and posterior decompression without column resection (PWCR)?for the surgical treatment of thoracic myelopathy.
Summary of Literature Review: The optimal surgical treatment of thoracic myelopathy remains a matter of debate.
Materials and Methods: Fifty-two patients with thoracic myelopathy who underwent surgical decompression and fusion (PVCR: 20 cases, AP: 11 cases, PWCR: 21 cases) were included in the analysis. For the radiological analysis, anterior vertebral height (AVH), posterior vertebral height (PVH), and the local kyphotic angle (LKA) were measured. The operation time and intraoperative blood loss were evaluated. A clinical analysis was conducted by comparing the neurological improvement and complication rates.
Results: LKA was 17.42° preoperatively, 4.23° postoperatively, and 8.86° at the last follow-up. The PVCR group showed a significantly greater correction of kyphosis (16.94°) than the AP (5.1°) and PWCR (1.52°) groups in postoperative follow-up examinations (p<0.001). No differences were found in the change in AVH. However, PVH decreased postoperatively in the PVCR group (p=0.001). The operation time was longer in the AP group (436 min, p<0.001), and blood loss was greater in the PVCR group (1643 cc, p=0.013). Neurological function improved in all groups postoperatively, and no significant differences were observed between groups either postoperatively or final follow up.
Conclusions: All three surgical techniques (PVCR, AP, and PWCR) were effective for the surgical treatment of thoracic myelopathy. PVCR was useful for kyphosis correction, but had greater blood loss. All three techniques led to improvements in neurological status.
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KEYWORD
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Thoracic myelopathy, Surgical treatment, Decompression and fusion, Posterior vertebral column resection
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