Closing-opening wedge osteotomy for correction of the thoracic and lumbar kyphosis in pediatric static tuberculosis

English Keywords:Spinal tuberculosis  Posterior surgical approach  Osteotomy  Kyphosis  Pediatric patient

English Abstract:

  【Abstract】 Objectives: To investigate the effect of closing-opening wedge osteotomy in correction of thoracic and lumbar kyphosis of pediatric static tuberculosis. Methods: From January 2010 to November 2012, a total of 21 pediatric patients with clear thoracic or lumbar kyphosis was treated in our hospital by using closing-opening wedge osteotomy. There were 14 males and 7 females, with the age ranging from 6 years to 14 years（mean 11.6±2.67 years）. The mean course of disease was 86.3±33.1 months(range, 58-142 months). The location of the tuberculosis distributed from T2 to L3, with 2 vertebrae affected in 4 cases, 3 vertebrae affected in 11 cases, and 4 vertebrae affected in 6 cases. Six cases presented with neurological compromise: Frankel C in 2 cases, and Frankel D in 4. The preoperative Cobb angle of kyphosis was 40°-110° (mean 68.4°±18.2°). Patients received closing-opening osteotomy, decompression, internal fixation and circumferential fusion in a posterior approach. Follow-up was performed at 3 months, 6 months, 12 months and each year thereafter. X-rays were used to evaluate the instrumentation′s status and the deformity correction. Results: All surgeries were carried out as planned, with a mean blood loss of 1100±244ml, ranging from 800ml to 1600ml, operation time ranged from 210min to 410min(mean, 270±74min). The number of instrumentation and fusion segments was 5 to 10 vertebrae(mean 6.8±1.6 vertebrae). One patient with T2-T5 scoliokyphosis and incomplete paraplegia presented neurofunction deterioration(Frankle grade C to B). No other complication such as cerebrospinal fluid leakage or wound infection was noted. The mean follow-up was 28.8±8.1 months(from 14 months to 38 months). The patient experiencing spinal injury during the operation improved from Frankle grade B to D at final follow-up. Another 5 patients with neurological deficit recovered completely. Cobb angle of kyphosis decreased to 4°-59° after operation(mean 24.6°±15.1°). At final follow-up, kyphosis angle was 4°-61°(25.9°±15.0°), with a loss of 0°-4°(mean 1.3°±0.3°). The differences of kyphotic angle between pre-operation and post-operation and between pre-operation and final follow-up were significant(P<0.05), while there was no significant difference between post-operation and the final follow-up. VAS score of back pain decreased from 4.3±1.1(2 to 7) at admission to 0.8±0.6(0 to 2) at final follow-up. The difference was also significant(P<0.05). Bone fusion was achieved in all cases, and no implant related complication was noted. Conclusions: Closing-opening wedge osteotomy is an effective way for the correction of kyphosis caused by static tuberculosis, and the clinical outcomes are good.