Anterior-Posterior Surgery Versus Posterior Closing Wedge Osteotomy in Posttraumatic Kyphosis With Neurologic Compromised Osteoporotic Fracture

Study Design. Retrospective study. Objectives. To compare the surgical results between combined anterior–posterior procedures and posterior closing wedge osteotomy procedures in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fractures. Summary of Background Data. Combined anterior–posterior procedures are usually recommended in cases of kyphotic deformities with neurologic deficit secondary to osteoporosis. However, combined anterior–posterior surgery is associated with significant morbidity in elderly patients. Materials and Methods. Twenty-six patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture were indicated for operative intervention using either a combined anterior–posterior surgery (n = 11) or a posterior closing wedge osteotomy procedure (n = 15). The results of the two procedures were analyzed. The average patient age at the operation was 62.6 years (range: 50–82) with a 12:14 male-to-female ratio. Mean follow-up was 3.5 years (range: 2.1–5.4). Preoperative interval from injury to operation was 15.4 months (range: 1–36). There were 20 thoracolumbar (T12-L1) fractures and six lumbar fractures indicated for operative intervention. Results. In the combined anterior–posterior group, the mean operative time was 351 minutes with a mean blood loss of 2,892 mL. In the posterior closing wedge osteotomy group, the mean operative time was 215 minutes with blood loss of 1,930 mL. Eighteen patients showed a postoperative improvement in Frankel grading, 64% (7/11) in the combined anterior–posterior group, and 73% (11/15) in posterior closing wedge osteotomy group. There were no neurologic or vascular complications in either group. In the combined anterior–posterior group, there were five complications: two postoperative pneumonias, one superficial infection, and two distal screw loosening. There were only two complications in the posterior closing wedge osteotomy group: two distal screw loosening. One of the four cases of distal screw loosening required surgical revision. The other three cases were treated by bracing for more than 6 months. Conclusions. Although technically demanding, the posterior closing wedge osteotomy procedure demonstrated a better surgical result with significant less mean operative time and mean blood loss (P < 0.05). It may be a better alternative than a combined anterior–posterior procedure in patients with posttraumatic kyphosis and neurologic compromise secondary to osteoporotic fracture.