The complications and management of posterior correction for moderate/severe kyphosis

English Keywords:Kyphosis  Kyphosis correction  Complication

English Abstract:

  【Abstract】 Objective：To investigate the complications and management of posterior kyphotic segmental resection and dual axial rotation correction for moderate/severe kyphosis.Method：From May 2004 to October 2009，posterior kyphotic segmental resection and dual axial rotation correction was performed in 40 patients with moderate/severe kyphosis.The pathological diagnosis included post-traumatic kyphosis in 3 cases，old tuberculous kyphosis in 26 cases，congenital semi-vertebral kyphosis in 10 cases，and iatrogenic（after operation for tumor） kyphosis in 1 case.The kyphotic apex sited at thoracolumbar segment and lower thoracic segment in 22 cases，at middle thoracic segment in 17 cases，at upper thoracic segment in 1 case.The X-ray，CT scan and MRI were routinely performed before surgery to measure the kyphotic Cobb′s angle，the kyphosis level and characteristics，as well as the compression of spinal cord were evaluated.The intra- and post-operative complications were summarized，and the relevant management undertaken was noted.Result：The average follow-up was 26.3 months.The average preoperative kyphosis Cobb′s angle was 89.7°，which decreased to 26.2° after surgery，with an average correction rate of 71.8%.The complications included dural tear in 3 cases，nerve root injury in 5 cases，prosthesis loosening in 1 case，osteotomy segment shift in 1 case，transient neurologic deficit in 2 cases due to dropping of blood pressure and ischemia of spinal cord，and instrumentation loosening and kyphosis recurrence in 1 case.All complications got good relief after relevant intervention including dural repair or covering of the defect，dehydration，methylprednisolone or mecobalamine treatment，and revision surgery for decompression.Conclusion：High surgical risk is noted in moderate/severe kyphosis correction.The complications should be managed cautiously, and the results are promising after proper intervention.