Vertebral column resection for post tuberculosis severe kyphotic deformity: Results of 5 year follow-up

Rathod, Tushar; Shah, Kunal Ajitkumar

doi:10.1016/j.jor.2019.11.036

Cited by 4 publications

(5 citation statements)

References 28 publications

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“…In our case, we achieved corrections of about 75%. The blood loss in our case was 1,100 mL, which is at par with the other published studies of Suk et al (2,933 mL) 5 , Wang et al (2,980 mL) 7 , and Rathod et al (1,013 mL) 8 . The other major complications of this surgery as reported by various authors include neurological injury, infection, pulmonary or air embolism, thrombophlebitis, pseudoarthrosis, bed sores, wound dehiscence, hardware failure or prominence, and superior mesenteric artery syndrome 9,10 .…”

Section: Discussionsupporting

confidence: 83%

“…(2,980 mL) 7 , and Rathod et al (1,013 mL) 8 . The other major complications of this surgery as reported by various authors include neurological injury, infection, pulmonary or air embolism, thrombophlebitis, pseudoarthrosis, bed sores, wound dehiscence, hardware failure or prominence, and superior mesenteric artery syndrome 9,10 .…”

Section: Discussionmentioning

confidence: 98%

“…All three approaches have their own advantages and disadvantages, but in authors’ experience, PVCR can provide the same or better results than other two approaches. The percentages of correction quoted in numerous studies following posterior-only approach include 61.9% (Suk et al) 5 , 57.8% (Rajasekaran et al) 6 , 82.3% (Wang et al) 7 , and 57.9% (Rathod et al) 8 . In our case, we achieved corrections of about 75%.…”

Section: Discussionmentioning

confidence: 99%

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Post-tubercular Lumbosacral Kyphotic Deformity in a 11-Year-Old Child

Mahajan,

Goswami,

Kumar

2024

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Case: An 11-year-old girl with intact neurology presented with a lumbosacral kyphotic deformity due to healed tuberculosis. Radiological imaging showed sagittal balanced spine with compensatory thoracic lordosis and cervical kyphosis. She underwent L4 and L5 posterior vertebral column resection (PVCR) with posterior instrumentation from L2 to pelvis. The patient demonstrated immediate correction of compensatory curves postoperatively. At 3-year follow-up, she returned to her activities of daily living with Oswestry Disability Index and Scoliosis Research Society scores of 12 and 4.8% respectively. Conclusion: Pediatric post-tubercular deformities in the lumbosacral region are rare. They can cause secondary changes in other regions, such as the loss of thoracic kyphosis or cervical lordosis. These deformities should be addressed at an early age to prevent structural changes in compensatory curves.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

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Post-tubercular Lumbosacral Kyphotic Deformity in a 11-Year-Old Child

Mahajan,

Goswami,

Kumar

2024

JBJS Case Connector

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“…Therefore, when compared to PSO and VCR, the following characteristics and benefits of DCVO can be summarized [8][9][10][11][12][13][14][15][16][17][18][19][20]26]: (1) Deformed complex vertebrae usually involve two or more vertebral bodies and the partial or total fusion of many segments' facet joints and intervertebral discs. Multiple deformed and fused vertebrae were treated as a single unit, which simplified complicated problems and aided in developing a more specific osteotomy within the unit and precise positioning during surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Until now, surgical osteotomy has been the leading choice for correcting the deformity and realigning the spine. Posterior column osteotomy (PCO) is not indicated as a first-line treatment for post-tubercular angular kyphosis because of the difficulty in decompressing the spine canal anteriorly and the relatively small correction angle [8][9][10]. Conversely, pedicle subtraction osteotomy (PSO) is a wedge-shaped resection in one vertebra which includes the partial vertebral body and posterior column elements and can only acquire correction of 30°-40° [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of deformed complex vertebral osteotomy in children with severe thoracic post-tubercular angular kyphosis

Zhang

Deng

Guo

et al. 2022

BMC Musculoskelet Disord

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Background Many surgical options have been described to manage post-tubercular kyphosis, but the standard approach for treating severe post-tubercular angular kyphosis in children has not been established yet. The present study was performed to evaluate the safety and efficacy of deformed complex vertebral osteotomy (DCVO) for the treatment of severe thoracic post-tubercular angular kyphosis (> 70°) in children. Methods Deformed complex vertebrae indicated that multiple deformed and fused vertebrae were usually involved with two or more vertebral bodies and the partial or total fusion of many segments' facet joints and intervertebral discs. Thus, DCVO indicated that a wider posterior wedge-shaped and three-column osteotomy was performed within deformed complex vertebrae to correct a more extensive range of angles. From 2010 to 2017, 15 children who suffered from severe thoracic post-tubercular angular kyphosis underwent DCVO. Deformed complex vertebrae involved two vertebral bodies in 9 patients and three vertebral bodies in 6 patients. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed preoperatively and at the final follow up. This was a retrospective study analysing the outcome after grade 4/5 spinal osteotomies in deformed complex vertebrae. Results The mean duration of surgery was 239 ± 37.81 min. The average period of follow-up was 31.6 ± 6.98 months. The preoperative mean kyphosis of deformed complex vertebrae was 83.39° ± 9.04°; the mean thoracic kyphosis (TK) and lumbar lordosis (LL) were 81.09° ± 8.51° and 80.51° ± 7.64°, respectively; the mean sagittal vertical axis (SVA) was 3.83 cm ± 1.43 cm. The postoperative mean kyphosis of deformed complex vertebrae was reduced to 19.98° ± 2.47° (P < 0.001) with a mean kyphosis correction of 63.41°; at the final follow up, it was 18.4° ± 2.29° (P < 0.001) without obvious loss of correction. The postoperative mean TK, LL, and SVA were reduced to 24.05° ± 3.84°, 46.9° ± 3.53°, and 0.6 cm ± 0.34 cm, respectively (P < 0.001 for all); and there was no obvious loss of sagittal alignment and balance at the final follow up (p = 0.982, p = 0.604, p = 0.754). Complicated with neural dysfunction preoperatively, 5 Frankel's grade D cases showed complete neurological recovery at final follow up. VAS score reduced from 3.6 ± 1.18 to 0.87 ± 0.64 (P < 0.001); and ODI score reduced from 22.21 ± 6.93 to 5.02 ± 2.6 (P < 0.001) at the final follow up. Conclusions DCVO was an individualized osteotomy for treating severe thoracic post-tubercular angular kyphosis in children and could be safe and effective in reducing the incidence of complications and significantly improving kyphosis correction.

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