Severe kyphotic deformity in tuberculosis of the spine

Tuli, SM

doi:10.1007/bf00181121

Cited by 140 publications

(130 citation statements)

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“…Within the musculoskeletal system TB mostly involves (nearly 50%) the spinal column primarily in the upper lumbar and lower thoracic spine [10]. The bony destruction and vertebral collapse often results in significant kyphosis, presenting clinically as a painful gibbus, creased instability, vertebral body translations and increased risk of neurologic involvement [4,17]. An extremely severe kyphosis, however, with the sagittal Konstam's angle beyond 90°, not only disfigures the body, but also carries psychological implications, difficulties with employment.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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Extremely severe Pott's kyphotic deformity cannot be completely corrected by conventional techniques, including vertebral body resection, Smith-Peterson, pedicle subtraction osteotomy or even vertebral column resection (VCR). The authors developed a new technique combining transpedicular eggshell osteotomies and VCR as multilevel modified vertebral column resection (MVCR) through a single posterior approach for surgical treatment of Pott's kyphosis with Konstam's angle beyond 90°. A total of 9 patients (6 males, 3 females) in our institution with severe Pott's kyphosis who underwent single-stage posterior-only multilevel MVCR were retrospectively reviewed. The candidates for multilevel MVCR were those with a sharp, angular kyphosis in the lower thoracic or upper lumbar spine with a Konstam's angle beyond 90°.

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Section: Introductionmentioning

confidence: 99%

“…An extremely severe kyphosis, however, with the sagittal Konstam's angle beyond 90°, not only disfigures the body, but also carries psychological implications, difficulties with employment. Patients so affected may develop lateonset paraplegia, cardiopulmonary dysfunction or painful costo-pelvic impingement [9][10][11][12]17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…1 Approximately 30 million patients are treated because of tuberculosis in the world and 8 million new cases are added every year. 2 Tuberculosis involves mostly (nearly 50%) the spinal column in the musculoskeletal system. 2 Tuberculosis of the spine has two major complications: neurological de®cit and the kyphosis.…”

Section: Introductionmentioning

confidence: 99%

Late onset Pott's paraplegia

et al. 2000

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Background: Pott's disease may cause late neurological involvement due to development of sharp kyphosis. Anterior decompression and fusion is the treatment of choice for this disorder. Objective: To determine the mid-term clinical results of patients with late onset Pott's paraplegia, who underwent anterior decompression and grafting after neurological deterioration. Setting: A university hospital in I . stanbul, Turkey. Methods: Eight patients who developed late onset paraplegia with a mean period of 24.6 years (range, 9 ± 46 years) after the active disease were treated with anterior decompression and grafting. The mean age at surgery was 36.1 years (range, 18 ± 63 years) and the mean duration of neurological deterioration before surgery was 7.4 weeks (range, 2 ± 13 weeks). The mean kyphosis angle of the patients was 105.638 (range, 808 ± 1358). No attempt to correct the curve was made in any operation. All but two patients' neurological status were evaluated according to the International Standards for Neurological and Functional Classi®cation of Spinal Cord Injury determined by ASIA-IMSOP on admission. Results: Neurological status of all patients showed progression either in Frankel scale or in motor scores in the early postoperative period. One patient needed to be reoperated on because of a deterioration of neurological status 26 months after surgery. The mean length of time since the operations is 75.9 months (range, 48 ± 173 months) and all the patients are carrying out their lives independently with a mean motor score of 97.5 and full pin-prick and light touch scores. Conclusions: Anterior decompression and grafting is an e ective procedure for the treatment of late onset paraplegia in Pott's disease. Spinal Cord (2000) 38, 669 ± 674

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“…When the disease is severe with extensive vertebral destruction, due to increasing kyphosis, the superior healthy vertebra rotates forward till it comes into contact with the inferior vertebra. Such patients (3-5%) end up with a deformity greater than 60° [19]. In certain cases, the kyphotic deformity can further increase gradually with time.…”

Section: Diagnostic Imaging Section (Figs 1 2 3)mentioning

confidence: 99%

“…It also affects the child functionally due to costopelvic impingement, respiratory impairment and late-onset paraplegia [19,20]. Patients with kyphosis having significant pain, neurological deficit, impending buckling, functional or cosmetic disability will require surgical correction of the deformity.…”

Section: Diagnostic Imaging Section (Figs 1 2 3)mentioning

confidence: 99%

Closing–opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis

2010

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Childhood spinal tuberculosis, especially when associated with severe vertebral destruction of more than two vertebral bodies can end up in severe deformity. These children show progressive deformity throughout the period of growth and can develop severe kyphosis of [100°. Such kyphosis is severely disabling with significant risk of neurological deficit and respiratory compromise. Surgical correction of these deformities by both anterior and posterior approaches has been described but each have serious limitations of approach, correctability and safety. We describe here a technique of posterior closing-anterior opening osteotomy, which allowed us to correct a rigid post-tubercular deformity of 118°in a 13-year-old boy with neglected spinal tuberculosis. The patient was a 13-yearold boy, who had contracted spinal tuberculosis at the age of 6 years. Although the disease was cured by anti-tubercular chemotherapy, he continued to deteriorate in deformity and presented to us with severe thoracolumbar kyphosis (118°). He was neurologically intact but was beginning to show shortness of breath on exertion. Patient also had fore shortening of the trunk with impingement of the rib cage on the iliac crest. Radiographs revealed complete destruction of T12, L1 and L2 vertebral bodies with the T11 vertebra fusing with L3 anteriorly. CT scans and MRI revealed severe collapse of the vertebral column and the spinal cord being stretched over the 'internal gibbus', which was formed by the remnants of the destroyed vertebrae. A single stage closing-opening osteotomy was done by a midline posterior approach with continuous intraoperative spinal cord monitoring. The procedure involved extensive laminectomy of T11-L2, pedicle screw fixation of three levels above and three levels below the apex, a wedge osteotomy at the apex of the deformity from both sides, anterior column reconstruction by appropriate-sized titanium cage and gradual correction of deformity by closing the posterior column using the cage as a fulcrum. This allowed us to achieve a correction to 38°(68% correction). There was no intraoperative or perioperative adverse event and patient had good functional and Electronic supplementary material The online version of this article

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Severe kyphotic deformity in tuberculosis of the spine

Cited by 140 publications

References 14 publications

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

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

Late onset Pott's paraplegia

Closing–opening wedge osteotomy for severe, rigid, thoracolumbar post-tubercular kyphosis

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