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Analysis of the Risk Factors for Unfavorable Radiologic Outcomes after Fusion Surgery in Thoracolumbar Burst Fracture : What Amount of Postoperative Thoracolumbar Kyphosis Correction is Reasonable?

Journal of Korean Neurosurgical Society 2019년 62권 1호 p.96 ~ 105
서동광, 김정환, 정상구, 김문규, 최수정, 박진훈,
소속 상세정보
서동광 ( Seo Dong-Kwang ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurosurgery
김정환 ( Kim Chung-Hwan ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Orthopaedic Surgery
정상구 ( Jung Sang-Ku ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Emergency Medicine
김문규 ( Kim Moon-Kyu ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Neurosurgery
최수정 ( Choi Soo-Jung ) - University of Ulsan College of Medicine Gangneung Asan Hospital Department of Radiology
박진훈 ( Park Jin-Hoon ) - University of Ulsan College of Medicine Asan Medical Center Department of Neurosurgery

Abstract


Objective: The aims in the management of thoracolumbar spinal fractures are not only to restore vertebral column stability, but also to obtain acceptable alignment of the thoracolumbar junction (T-L junction) to prevent complications. However, insufficient surgical correction of the thoracolumbar spine would be likely to cause late progression of abnormal kyphosis. Therefore, we identified the surgical factors that affected unfavorable radiologic outcomes of the thoracolumbar spine after surgery.

Methods: This study was conducted in a single institution from January 2007 to December 2013. A total of 98 patients with unstable thoracolumbar spine fracture were included. In these patients, fixation was done through transpedicular screws with rods by three surgical patterns. We reviewed digital radiographs and analyzed the images preoperatively and postoperatively during follow-up visits to compare the change of the thoracolumbar Cobb angle with radiologic parameters and clinical outcomes. The unfavorable radiologic group was defined as the patients who were measured as having greater than 20 degrees of thoracolumbar Cobb angle on the last follow-up, or who underwent kyphotic progression of thoracolumbar Cobb angle greater than 10 degrees from the immediate postoperative state to final follow-up, or who had overt instrument failure with/without additional surgery. We assessed the risk factors that affected the unfavorable radiologic outcomes.

Results: We had 43 patients with unfavorable radiologic outcomes, including 35 abnormal thoracolumbar alignments and 14 instrumental failures with/without additional surgery. The multivariate logistic regression test showed that immediate postoperative T-L junction Cobb angle less than 10.5 degrees was a statistically significant risk factor, as well as the presence of osteoporosis (p=0.017 and 0.049, respectively).

Conclusion: Insufficient correction of thoracolumbar kyphosis was considered to be a major factor of an unfavorable radiological outcome. The spinal surgeon should consider that having a T-L junction Cobb angle larger than 10.5 degrees immediately after surgery could result in an unfavorable radiological outcome, which is related to a poor clinical outcome.

키워드

Spinal injuries; Thoracic vertebrae; Kyphosis; Risk factors

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