Transpedicular lower vertebral space osteotomy for thoracolumbar kyphosis secondary to old osteoporotic vertebral compression fractures

Background Despite rapid developments in spinal osteotomy techniques, many inevitable short- and long-term complications still occur. The objective of this study is to evaluate the clinical efficacy of transpedicular lower vertebral space osteotomy for the treatment of thoracolumbar kyphosis secondary to long-standing osteoporotic vertebral compression fractures and to explore more effective surgical methods to guide clinical practice. Methods We retrospectively analyzed the data of patients who were diagnosed with thoracolumbar kyphosis secondary to long-standing osteoporotic vertebral compression fractures and who underwent corrective surgery at our hospital between January 2014 and December 2020. The patients were divided into two groups: the pedicle subtraction osteotomy (PSO) group ( n = 16) and the transpedicular lower vertebral space osteotomy group ( n = 11). Operation time, bleeding volume, postoperative complications, and postoperative drainage were documented. Clinical outcomes were evaluated using the visual analog scale (VAS) score, the Oswestry Disability Index (ODI), and the kyphotic Cobb angle. Results During follow-up, it was found that there was no significant difference in the average degree of kyphosis correction between the PSO group and the transpedicular lower vertebral space osteotomy group. Compared with the corresponding preoperative values, the ODI and VAS scores in both groups showed significant improvement, while the complication rate was similar between the groups, and bony fusion was observed at the last follow-up. Conclusion Transpedicular lower vertebral space osteotomy was associated with shorter operative time and lower blood loss than PSO, while achieving comparable radiographic correction and clinical outcomes at the last available follow-up. Complication rates were not significantly different between groups. Larger studies with longer follow-up are warranted.