Transpedicular Decancellation Osteotomy in the Treatment of Posttuberculous Kyphosis

Bezer, Murat; Küçükdurmaz, Fatih; Güven, Osman

doi:10.1097/01.bsd.0000211271.89485.f1

Cited by 47 publications

(38 citation statements)

References 17 publications

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“…These authors have used segmental spinal instrumentation with pedicle screws and rods. In most of these reports, additional procedures such as posterior closing wedge osteotomy, and posterior inter-body fusion using bone grafts with or without cages have been performed [37,[39][40][41][42][43][44].…”

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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“…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.…”

Section: Surgery For Established Deformitymentioning

confidence: 99%

“…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.…”

Section: Surgery For Established Deformitymentioning

confidence: 99%

Kyphotic deformity in spinal tuberculosis and its management

Rajasekaran

2012

International Orthopaedics (SICOT)

122

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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.

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“…The closing and opening wedge osteotomy described by Kawahara et al [12] is essentially the same technique as posterior vertebral column resection described by Suk et al, which provides tremendous potential for deformity correction and appears to be the most powerful posterior osteotomy method. However, it carries a significant risk of complications, including potentially permanent neurological lesions [13][14][15][16]. Suk et al found a 34.3% overall rate of complications, a 17.1% rate of neurological complications and a 7.1% fixation failure in a series of 70 patients [13].…”

Section: Discussionmentioning

confidence: 99%

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

Yang

Lin

et al. 2010

International Orthopaedics (SICOT)

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The correction of severe thoracic deformities is challenging. However, the usual imaging modalities are not sufficient for performing the surgery. Our objective was to describe the procedure and results of posterior modified wedge osteotomy aided by the techniques of computeraided design-rapid prototyping (CAD-RP) to correct thoracic deformities. Twenty-one patients with thoracic deformities (eight males; 13 females) formed the study group. All patients underwent computed tomography (CT) scanning and CAD-RP, and a model of thoracic deformities and navigation templates of pedicles were created for each patient and used to analyse the spinal deformities and serve as anatomical reference. Aided by these models, personalised modified wedge osteotomy combining the eggshell technique and posterior vertebral column resection was performed. Using CAD-RP improved the safety and accuracy of surgery and screw placement in the 21 patients in whom 41 vertebrae were removed and 216 pedicle screws were placed. The average operation time was 260 (200-420) min, with an average blood loss of 1,900 ml (range 800-3560 ml). The percentage of deformity correction was 56.3% (from 72.1°to 31.5°) in the coronal plane and 60.4% (from 81.6°to 32.3°) in the sagittal plane. No patient had serious complications or implant failure. Personalised single-stage posterior modified wedge osteotomy is an effective procedure for treating thoracic deformities. Using CAD-RP and the RP models have significant benefits for personalised surgical treatment of complex thoracic deformities.

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Transpedicular Decancellation Osteotomy in the Treatment of Posttuberculous Kyphosis

Abstract: The transpedicular decancellation osteotomy effectively corrected the sagittal balance and improved pain and functional status. It was a safe and reliable technique in the treatment of posttuberculosis kyphosis.

Cited by 47 publications

References 17 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

Kyphotic deformity in spinal tuberculosis and its management

Personalised modified osteotomy using computer-aided design–rapid prototyping to correct thoracic deformities

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