Surgical Treatment of Angular Pott’s Kyphosis with Posterior Approach, Pedicular Wedge Osteotomy and Canal Widening

Abstract

Background:It has been observed that the correction of severe posttuberculous angular kyphosis is still a challenge, mainly because of the neurologic risk.Methods:Nine patients were reviewed after surgery (mean follow-up 18 months). There were 2 thoracic, 4 thoraco-lumbar and 3 lumbar kyphosis. The mean age at surgery was 23.Clinical results were evaluated by the Oswestry Disability Index (ODI) and by the neurologic evaluation. Preoperative, postoperative and final follow-up X-rays were assessed.The surgery included a posterior approach with cord release and correction by transpedicular wedge osteotomy and widening of the spinal canal.Results:Average kyphotic angulation was 72° before surgery, 10° after surgery and 12° at follow-up. Three out of four patients with neural deficit showed improvement. Neurologic complications included a transitory quadriceps paralysis, likely by foraminal compression of the root.Conclusion:A posterior transpedicular wedge osteotomy allows a substantial correction of the kyphosis, more by deflexion than by elongation, with limited neurologic risks. However it is mandatory to widely enlarge the spinal canal on the levels adjacent to the osteotomy, in order to allow the dura to expand backwards.

Posterior-Only Approach for the Correction of Severe Post-tubercular Kyphosis

“…The correction is complex and could be staged or with multiple approaches and consequent high risk of complications. In severe kyphosis, several publications have highlighted the pitfalls of shortening the posterior column excessively and recommended simultaneous insertion of bone graft or metallic cage to open up and expand the hitherto collapsed anterior column (the closing-opening wedge osteotomy) [8][9][10][11][12].…”

Recent Advances in Technique and Clinical Outcomes of Minimally Invasive Spine Surgery in Adult Scoliosis

“…[ 1 2 ] The aims of surgical treatment of adult scoliosis are to obtain coronal and sagittal alignment, pain relief, and solid fusion. [ 3 ] Conventional open spinal surgery, which could improve Oswestry Disability Index (ODI)[ 4 ] and achieve pain relief, functional restoration, and satisfaction,[ 5 ] is widely used in the operative decompression and correction of the deformity. To decompress and reconstruct the alignment of the spine, multilevel surgery is usually needed, and this is often associated with large quantity of blood loss and longer time for anesthesia which are harmful to elderly people, especially who are suffered from complications.…”

“…[ 6 ] Meanwhile, large operative scars may bring high psychological and physiological burden to patients. [ 4 5 6 7 8 ] The incidence of complications for conventional surgery was reported from 20% to 80% in recent studies. [ 6 9 10 ] For the purpose of reducing these undesirable effects and complications caused by traditional open spinal surgeries, the minimally invasive spine surgery (MISS) was developed.…”