Kyphotic deformity in spinal tuberculosis and its management

Abstract

Spinal tuberculosis is the most common cause of severe kyphosis in many parts of the world. Three percent of patients treated conservatively end up with a deformity greater than 60 degrees which can cause serious cosmetic, psychological, cardio-respiratory and neurological problems. Severe kyphotic deformities are usually the result of childhood spinal deformities and 'Spine at risk' radiological signs are helpful to identify children at risk of deformity. In children, a severe type of collapse, termed as 'Buckling Collapse' is also noted where the kyphosis is more than 120 degrees. Risk factors for buckling collapse include an age of less than seven years at the time of infection, thoracolumbar involvement, loss of more than two vertebral bodies and the presence of radiographic 'Spine-at-risk' signs. In correction of established deformity, posterior only surgery with a variety of osteotomies is now preferred. In patients with deformity of more than 90 degrees, an opening-closing wedge osteotomy must be done to prevent neurological deficit.

Vertebral Distribution of Pott's Disease of the Spine among Adult Sudanese Patients in Khartoum, Sudan

“…This disc space narrowing occurs either due to destruction of subcondral bone of vertebral bodies with subsequent herniation of the disc or by direct invasion of the disc itself. Paraspinal abscesses may be seen quite early, presenting as fusiform or rounded shadows of water density 19 . Regarding the most affected vertebral levels, our findings are similar to those internationally reported.…”

Research Article Correlation analysis of ADAMTS-4, VCAM-1, and TAK1 expression in cartilage tissue from spine tuberculosis.

“…Currently, there is still a lack of consensus on a single standard mechanism for its pathogenesis. Various factors can induce spinal tuberculosis, such as hereditary predisposition, immune response, inflammatory mediators, and imbalance of the cartilage matrix microenvironment Rajasekaran, 2012). Spinal tuberculosis progresses through multiple stages and involves a variety of cytokines.…”

Infections of the spine are still a great problem

“…In his review article, Rajasekaran [19] describes the buckling collapse, the spineat-risk signs and surgery for active disease or established deformity. Liu et al [20] present a series of cervical kyphosis treated through an anterior approach, with debridement and reconstruction using grafts or cages accomplishing a correction in the order of 50°.…”