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KMID : 1189320100040010007
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Asian Spine Journal
2010 Volume.4 No. 1 p.7 ~ p.14
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Factors Affecting Clinical Results after Corrective Osteotomy for Lumbar Degenerative Kyphosis
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Kim Whoan-Jeang
Kang Jong-Won
Kang Sung-Il
Sung Hwan-Il
Park Kun-Young
Park Jae-Guk
Kwon Won-Cho
Choy Won-Sik
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Abstract
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Study Design: This study is a prospective, clinical study for lumbar degenerative kyphosis.
Purpose: To determine the factors affecting postoperative clinical outcomes in patients who undergo corrective osteotomy for lumbar degenerative kyphosis.
Overview of Literature: Only a small number of studies have reported clinical results for surgery for lumbar degenerative kyphosis. There are almost no studies about prognostic factors that predict postoperative clinical results.
Methods: This study involved 25 patients who were diagnosed with lumbar degenerative kyphosis and who underwent corrective osteotomy following gait analysis. A pedicle subtraction osteotomy was done at the third lumbar vertebra (L 3). Regarding the fusion level, surgery was done within a range from T10 proximally to S1 distally. Of these, for rigid fixation of a distal part, an iliac screw was used. Pain was evaluated using a 10-point pain scale and a questionnaire about activities. We also evaluated cosmesis and subjective satisfaction using a modified version of the Scoliosis Research Society Outcome-22 (SRS-22) instrument. This assessment was done using a 5-point scale which was designed by us. We assigned patients to group A (good clinical outcomes) if their postoperative pain score was lower than 4 (of 10 points) and if scores indicating activity, cosmesis and subjective satisfaction were higher than 11 (of 15 points). All other patients were assigned to group B (poor clinical outcomes).
Results: Clinical outcomes were good in 64% of patients (16/25) and poor in 36% (9/25). Regarding cosmesis and subjective satisfaction, there were significant differences between the two groups. There were also significant differences in physical factors of individual patients such as body mass index (BMI): 23.78 ± 2.79 in group A and 26.44 ± 2.75 in group B. On gait analysis, there was a significant difference in the dynamic pelvic tilt: 7.5 ± 3.3° in group A and 11.72 ± 1.89° in group B.
Conclusions: There is no correlation between preoperative degree of kyphotic deformity and clinical outcomes. The degree of anterior rotation of pelvic tilt does not change significantly; rather, compensatory mechanisms of the pelvis and BMI were found to have more influence. Because neither the degree of satisfaction with clinical outcomes nor the increased activity was relatively higher, a more sincere decision should be made before recommending corrective osteotomy for degenerative lumbar kyphosis.
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KEYWORD
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Lumbar degenerative kyphosis, Dynamic pelvic tilt, Radiological assessment, BMI and clinical outcomes
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