Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site

Boachie-Adjei, Oheneba; Papadopoulos, E.; Pellisé, Ferràn; Cunningham, Matthew E.; Pérez-Grueso, Francisco Sánchez; Gupta, Munish C.; Lonner, Baron S.; Paonessa, Kenneth J.; King, Akilah; Sacramento, Cristina Carla; Kim, Hee Jin; Mendelow, Michael J.; Yazıcı, Muharrem

doi:10.1007/s00586-012-2338-4

Cited by 55 publications

(50 citation statements)

References 29 publications

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“…6 Surgical correction of severe kyphosis, along with decompression of the cord and debridement of the tuberculosis-destroyed vertebral bodies, is best to avoid late-onset paraplegia. 7 Several different surgical procedures were available for treating spinal deformities. [8][9][10] These techniques take a one-stage correction for spine deformity, and undoubtedly increase surgicalrelated complications, such as large-vessel injuries, neurological injuries (cord, roots, nerves), dural tears, and stabilization failure.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction

Zhu

Zhao

et al. 2016

SPINE

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Section: Discussionmentioning

confidence: 99%

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction

Zhu

Zhao

et al. 2016

SPINE

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“…The correction of a severe deformity with sharp angular kyphosis requires an osteotomy of the three columns [7]. Yau [8] popularized a staged technique and progressive correction using halo-pelvic traction.…”

Section: Discussionmentioning

confidence: 99%

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

Kinkpé

Onimus²,

Sarr

et al. 2017

Open Orthopaed. J.

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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.

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“…In cases of severe deformity, vertebrectomy is an appropriate technique that makes circumferential decompression and correction of kyphosis possible. 7 In recent years, spine surgeons have increasingly adopted posterior vertebrectomy or posterior vertebral column resection (PVCR) in the surgical treatment of rigid spinal deformities. According to the Schwab classification of vertebral osteotomies, 8 the multiple-level PVCR falls under type IV, which corresponds to osteotomies with a greater degree of complexity and should be used as the last resort in the correction of severe, rigid, and principally angular deformities.…”

Section: Introductionmentioning

confidence: 99%

Posterior Vertebral Column Resection in Multiple Levels in Children With Vertebral Tuberculosis

et al. 2019

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Objective: To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods: Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results: All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions: Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series. RESUMOObjetivo: Avaliação dos resultados clínicos e radiológicos da vertebrectomia posterior multinível no tratamento da cifose por tuberculose vertebral em crianças menores de 9 anos apresentando déficit neurológico. Métodos: Estudo retrospectivo de uma série de 5 casos, sendo 4 do sexo feminino e 1 do sexo masculino, média de idade de 4,7 anos na época da cirurgia, portadoras de tuberculose vertebral múltiplos níveis, com média de cifose de 89°. Resultados: Todos os pacientes foram submetidos ao tratamento cirúrgico com RCVP múltiplos níveis, com número médio de 3,6 vértebras ressecadas, média de tempo cirúrgico de 359 minutos, período médio de internação pós-operatória de 21,2 dias. O seguimento médio foi de 29 meses. A média de correção da cifose foi de 62,6%. Antes da cirurgia, todos os pacientes tinham sinais de sofrimento medular, sendo que um deles não apresentava déficit de força ou sensibilidade (ASIA E), porém havia a presença de sinais piramidais e história de quedas. Os outros 4 possuíam algum grau de disfunção sensitivo-motora, com escore ASIA variando de A a D. Como complicações pós-operatórias ocorreram duas deiscências de sutura, um pneumotórax e uma pneumonia, todas com evolução favorável. Quatro pacientes evoluíram com melhora neurológica e um deles apresentou manutenção do déficit neurológico até o último seguimento. Conclusão: A RCVP múltiplos níveis se mostrou uma opção segura e eficaz no tratando da cifose na TB vertebral em crianças com déficit neurológico. Nível de evidência IV; Série de Casos. Descritores: Tuberculose da Coluna Vertebral; Compressão da Medula Espinhal;...

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Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site

Abstract: The correction of deformity is only feasible with three-column osteotomies, and posterior vertebral column resection (PVCR) is the treatment of choice in extreme kyphosis. The prognosis of the neurologic deficit (late paraplegia) is dependent on the extent of gliosis of the spinal cord.

Cited by 55 publications

References 29 publications

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction

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

Posterior Vertebral Column Resection in Multiple Levels in Children With Vertebral Tuberculosis

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