Kyphus Correction in Spinal Tuberculosis

Abstract

Late-onset paraplegia is best avoided by correcting severe kyphosis in the active, healing, or healed stages of spinal tuberculosis. We report 16 patients with dorsal or dorsolumbar spinal TB--nine with paraplegia, seven without paraplegia--who underwent kyphus correction. Nine patients had active, five partially treated, and two healed disease. The patients ranged in age from 3 to 38 years and had a mean kyphosis of 58.5 degrees (range, 35 degrees-76 degrees). Mean vertebral body involvement on computed tomography was 4.2 (2-9), and mean initial vertebral body loss was 1.76 (1-2.6). The sequential steps for kyphus correction were anterior corpectomy, shortening of the posterior column, posterior instrumentation and anterior gap grafting, and posterior fusion as a single-stage procedure by the extrapleural anterolateral (costotransversectomy) approach. Minimum followup was 3 months (range, 3-36 months). All but one patient with neural deficit showed complete neural recovery. Mean kyphosis correction was 27.3 degrees (range, 9 degrees-42 degrees). Mean correction loss on 1-year followup was 1.4 degrees (range, 0 degrees-4 degrees).

Determinants of Neurological Outcome in Surgically Treated Patients of Pott's Spine

“…Radiological outcome (both X-ray and MRI) also showed a significant reduction from more severe to less severe grades and a significant increase in Cobb's Angle. Similar to results of present study, some other workers 7,8,12,13 , who surgically intervened for correction of kyphosis also showed a significant increase in Cobb's angle. In present study, at final evaluation (i.e.…”

Kyphotic deformity in spinal tuberculosis and its management

“…'Transpedicular decancellation osteotomy', 'pedicle subtraction osteotomy', 'direct internal kyphectomy' have been used to treat kyphosis in active as well as healed disease. Anil Jain et al [28] reported kyphosis correction through an extra-pleural, antero-lateral (costo-transversectomy) approach with mean kyphosis correction of 27.3°and no persistent neurodeficits. Bezer et al [29] used a 'transpedicular decancellation osteotomy' to correct post tuberculous deformity with no neural complications.…”

“…Later refinement of surgical techniques, development of newer approaches and availability of rigid spinal instrumentation made single stage correction of established deformity relatively safe and a procedure with good outcome [28,29]. 'Transpedicular decancellation osteotomy', 'pedicle subtraction osteotomy', 'direct internal kyphectomy' have been used to treat kyphosis in active as well as healed disease.…”

Surgical Treatment of Kyphosis in Children in Healed Stages of Spinal Tuberculosis

“…[12][13][14] Kyphus correction surgery involves anterior corpectomy to achieve decompression, shortening of the posterior column, posterior instrumentation, and anterior and posterior bone grafting. 15 In children, posterior fusion should be attached more importance. On the understanding of such principle, we designed this kind of combined anterior and posterior surgery for children.…”