Posterior vertebral column resection with dual axial rotation correction for severe kyphosis secondary to tuberculosis

English Keywords:Post-tuberculosis kyphosis  Vertebral column resection  Dual axial rotation  Kyphosis correction

English Abstract:

  【Abstract】 Objectives: To observe the results of posterior vertebral column resection with dual axial rotation correction for severe kyphosis secondary to tuberculosis. Methods: From May 2004 to September 2011, 33 cases with severe kyphosis secondary to tuberculosis underwent posterior vertebral column resection with dual axial rotation correction were reviewed retrospectively. There were 15 males and 18 females; the average age was 34.7±14.1 years(11-63 years), with 18 cases ≥35 years and 15 cases ＜35 years; the preoperation Cobb angle was 98.9°±18.2°(70.0°-130.0°), with 17 cases ≥100° and 16 cases ＜100°; the posterior convex apex located at the upper middle thoracic spine(T10 and upper) was noted in 19 cases, at the thoracolumbar or lumbar spine(T11 and under) in 14 cases. The spinal cord injury of Frankel grade of A and B was noted in 1 case, grade C in 5 cases, grade D in 12 cases, grade E in 14 cases. The preoperation ODI was 19.8±10.0. Cases were subgrouped on the basis of age, location of kyphosis apex, severity of kyphosis, Frankel grade, complication situation. The kyphosis angle was measured before and after surgery, as well as final follow-up. The sagittal balance condition of the spine, the height of person, the Frankel grading system for neurological function of lower extremities, the Oswestry disability index(ODI) for life quality, the visual analogue score(VAS) for low back pain and the patient satisfactory index(PSI) were recorded before surgery and at follow-up. The intra- and post-operative complications were summarized, and the relevant management undertaken was noted. Results: The average kyphosis angle was 98.9°±18.2° before surgery and decreased to 30.9°±11.3° after surgery, with a correction rate of 69.1%. The average kyphosis angle was 34.8°±15.1° at the final follow-up, with a correction rate of 65.3%. The sagittal balance of the spine, height of person, Frankel grade, Oswestry disability index and visual analogue score were improved to a certain extent. The PSI results showed a satisfying rate of 87.9%. The complications included 12 cases at intraoperation, 2 cases at early-stage and 4 cases at late-stage. The incidence rate of complications was 54.5% and all complications got good relief after the relevant intervention. The correction rate of kyphosis angle was not different between patients with and without complications, but the life quality and neurological function improvement were lower in patients with serious neurological complications. Conclusions: Posterior vertebral column resection with dual axial rotation correction and fusion is an effective way to treat severe kyphosis secondary to tuberculosis, good therapeutic efficacy and long-term prognosis can be obtained. It is very important to prevent the occurrence of serious neurological complications.