Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy

Abstract

Objective: This study aimed to evaluate the clinical effects of a posterior surgical strategy for rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis, especially emphasizing the management of adjacent segment degeneration. Design: This is a retrospective study. Setting: This study was performed at Union Hospital, Tongji Medical College, Wuhan, China Participants: A total of 11 patients with rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis were included. Interventions: Each patient underwent posterior vertebral column resection (PVCR) for the correction of kyphosis, and mPSO was used for decompression of the stenotic adjacent segments. Outcome measures: Postoperatively, clinical and radiological evaluation was assessed. Results: Eight patients underwent PVCR, and 4 patients underwent both the PVCR and mPSO procedures. The average operation time was 6.5 hours (4.5–7.5 hours). The kyphotic angle improved from 97.5 ± 21.3° preoperatively to 45.4 ± 17.2° postoperatively. According to the ASIA grading system, 8 patients recovered to grade E, 2 to grade D, and 1 patient to grade A. Conclusion: PVCR is an effective procedure for the correction of rigid angular kyphosis in patients with spinal tuberculosis. Adjacent segment degeneration is an important risk factor for causing neurologic deficits, and posterior surgical management for angular kyphosis of thoracolumbar tuberculosis and spinal decompression using mPSO are recommended.