Analysis of 17 cases of posterior vertebral column resection in treating thoracolumbar spinal tuberculous angular kyphosis

Abstract

ObjectiveThis study aims to explore the efficacy and safety of posterior vertebral column resection (PVCR) in treating thoracolumbar spinal tuberculous angular kyphosis (TSTAK).MethodsFrom January 2008 to January 2012, 17 TSTAK patients were treated surgically, including five males and 12 females, with an average age of 23.6 years, among five cases who had the kyphotic apical vertebrae located at the thoracic vertebrae, ten cases were located at the thoracolumbar segment, and two cases were located at the lumbar vertebrae. The kyphotic Cobb angle was measured in the preoperative, postoperative, and final follow-up, respectively, and the nerve function ASIA classification was assessed.ResultsThe mean operative time was 364 min; the average intraoperative blood loss was 2,218 ml; and the average intraoperative blood transfusion was 1,863 ml. Among the five patients with the preoperative nerve function as grade D, four of them recovered to grade E. The preoperative average Cobb angle was 81.3° ± 12.8°, while the postoperative average Cobb average was 17.3° ± 3.6°; while it was significantly improved than the preoperative (P < 0.01), the average kyphosis correction rate was 68.7% ± 6.5%; the postoperative average follow-up was 18.7 months, with an average correction loss as 3.3°.ConclusionPVCR could be safely and effectively used in TSTAK.

Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature

“…In cases with severe kyphosis, osteotomies are essential to reconstruct the sagittal alignment. Various techniques have been described for correcting post-tubercular kyphosis, including pedicle subtraction osteotomy [ 8 ], closing-opening wedge osteotomy [ 9 , 10 ], and vertebral column resection [ 11 – 18 ]. Due to the complexity of severe post-tubercular kyphosis and accompanying late-onset neurological deficits, posterior vertebral column resection (PVCR) seems to be the most effective surgery that allows for sufficient correction of the deformity and decompression of the spinal cord [ 12 – 14 , 16 , 17 ].…”

Correction of kyphotic deformity due to neglected fracture dislocation thoracolumbar spine with posterior vertebral column resection

“…Wafa and Elbadrawi in their 40 cases study of PVCR, found that the mean operative time is 249minute and blood loss 850ml. 2,8 In this case, operation time was 330minutes with blood loss 1800ml. More time consumed and blood loss as a consequence of bony union in the anterior column.…”

Anterior correction of angular kyphosis in children: description of the technique and analysis of clinical series

“…3 Данные пациента З., 11 лет, с патологическим переломом Th 7 позвонка (по данным исследования операционного материала -хронический неспецифический спондилит) Th 7 , угловой грудной кифоз Th 6 -Th 8 38°: а -МРТ перед операцией; б -операционные фотографии на этапах коррекции дистрактором Caspar: введение винтов в тела позвонков, установка титановой блок-решетки; в -рентгенологический контроль дистракции; г -рентгенограммы позвоночника после операции: остаточный кифоз 9°, коррекция деформации 29°а Формирование угловых кифозов, достигающих 60° и более, встречается на фоне естественного течения туберкулезного спондилита в 3-5 % случаев [13]. Ретроспективный анализ 17 случаев VCR при данной патологии свидетельствует как о коррекции деформации в среднем на 68,7 ± 6,5 %, так и о высоких средних показателях кровопотери (M = 2218 мл) и длительности операции (6 ч 4 мин) [14]. Модифицированный вариант задней вертебротомии через дугу позвонка у детей с посттуберкулезными угловыми кифозами в возрасте 11 ± 5 лет позволил снизить продолжительность операции в среднем до 4 ч 16 мин и кровопотерю до 870 мл [15], что, остается весьма значительным показателем и при пересчете на ОЦК достигает 40 %.…”