The safety and reliability of posterior vertebral column decancellation for the management of Pott′s sharp kyphosis deformity

English Keywords:Pott′s deformity  Kyphosis  Vertebral column decancellation  Bony cage

English Abstract:

  【Abstract】 Objectives: To explore the safety and effectiveness of bony cage rather than titanium mesh in posterior vertebral column decancellation(PVCD) in the management of Pott′s sharp kyphosis deformity. Methods: Prospective analysis of 26 patients with Pott′s deformity underwent PVCD from August 2010 to May 2014, with a minimun follow-up of 1 year and a maximun follow-up of 5 years. There were 11 males and 15 females with an average age of 24.8±7.6 years old. Among them, the number of apical vertebrae located in thoracic region, thoracolumbar region and lumbar region was 6, 18 and 2, respectively. 1 patient was in grade C, 4 patients were in grade D and 21 patients were in grade E according to ASIA scale. The perioperative data were recorded, which included preoperative Cobb angle, postoperative Cobb angle, final follow-up Cobb angle, apical vertebrae, the length difference of anterior column and posterior column, operation time, perioperative blood loss and complications. Results: The average operation time was 306.2±59.5mins. The average blood loss was 2046.2±742.4ml. Complications were noted in 5 patients. 2 cases were complicated with transient neurological deficits and 3 cases with cerebrospinal fluid(CSF) leak. The kyphosis Cobb angle decreased from 91.3°±17.5° to 17.1°±6.2°, with a correction rate of (80.9±6.6)%. The average time of follow-up was 30.8±16.5 months. The Cobb angle was 20.3°±6.1° and the loss of correction was 3% in the final follow-up. The anterior column increased by 3.6±3.1cm while posterior column shortened by 2.7±1.1cm. Among 5 patients with preoperative neurological deficit, one patient with ASIA C improved to ASIA D, 3 patients improved from ASIA D to ASIA E, one patient with ASIA D did not recover in the last follow-up. Conclusions: PVCD without using conventional titanium mesh is a safe and effective option for Pott′s deformity.