Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity

Wang, Yan; Zhang, Yonggang; Wang, Zheng; Mao, Keya; Cao, Chao; Zheng, Guoyan; Li, Gang; Wood, Kirkham B.

doi:10.1007/s00586-009-1067-9

Cited by 60 publications

(51 citation statements)

References 18 publications

(27 reference statements)

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“…It is better to add fusion along with instrumentation in these categories of patients to minimize the risk of pseudarthrosis. Management techniques in severe post tubercular kyphosis have been discussed in detail by other authors [46][47][48].…”

Section: Discussionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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Section: Discussionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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“…The kyphosis angle was measured between the superior endplate of the first healthy vertebra above the deformity and the inferior endplate of the first healthy vertebra below the deformity. 29 Sagittal balance was measured by the horizontal distance from the C-7 plumb line to the posterior-superior corner of S-1 on full-length standing lateral spine radiographs. 9 A negative sagittal balance was noted when the C-7 plumb line fell posterior to the posterior-superior corner of S-1, and a positive sagittal balance was defined as the C-7 plumb line falling anterior to the sacral promontory.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up

Liu

Wang

et al. 2016

SPI

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OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.

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“…Mean preoperative kyphosis of 100 degrees was corrected to 16 degrees. All patients achieved fusion [36]. Deng et al reported on 34 patients with tuberculous kyphosis treated by vertebral resection.…”

Section: Osteotomies and Vertebral Column Resectionmentioning

confidence: 99%

“…Wang et al treated nine patients with tuberculous kyphosis with a lateral kyphotic angle of greater than 90 degrees combining transpedicular eggshell osteotomies and multilevel vertebral column resection through a single posterior approach [36,50]. Mean preoperative kyphosis of 100 degrees was corrected to 16 degrees.…”

Section: Osteotomies and Vertebral Column Resectionmentioning

confidence: 99%

“…Anterior debridement may be followed by anterior reconstruction with bone graft and either anterior or posterior instrumentation [2,7,12,13,[15][16][17][18][19][20][21][22][23]. For larger degrees of kyphotic deformity (greater than 80 degrees of kyphosis) and stiffer curves (less than 25% flexibility), several types of osteotomies may be helpful in increasing curve flexibility [24][25][26][27][28][29][30][31][32][33][34][35][36][37].…”

Section: Overview Of Surgical Treatmentmentioning

confidence: 99%

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Surgical correction of kyphotic deformity in spinal tuberculosis

Issack

Boachie-Adjei

2011

International Orthopaedics (SICOT)

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Purpose Approximately 5% of patients with spinal tuberculosis will develop a severe kyphotic deformity resulting in increased potential for pain, spinal cord compression, cardiopulmonary dysfunction, costopelvic impingement and cosmetic concerns. This manuscript reviews the evaluation and surgical management of tuberculous kyphosis. Methods This is a review article. Results Risk factors for the development of severe kyphosis include those who develop spinal tuberculosis as children, multiple vertebral body involvement and thoracic spine involvement. These complications can be prevented by early diagnosis and treatment of spinal tubercular lesions at stages with little to no deformity. When tubercular lesions result in progression of kyphosis to more than 50 degrees, the deformity should be surgically corrected to avoid problems associated with sagittal imbalance. There are several operations described for the treatment of kyphosis secondary to tuberculous spondylitis. The type of the operation depends on the magnitude of correction required. Conclusions Anterior, posterior and combined techniques as well as osteotomies and vertebral column resection have been described to correct spinal alignment and restore sagittal balance.

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Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity

Cited by 60 publications

References 18 publications

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up

Surgical correction of kyphotic deformity in spinal tuberculosis

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