Correction in a severe post-tuberculosis kyphosis using modified posterior vertebral column resection

Abstract

Introduction: Kyphotic Deformity is one of the complications that affect the quality of life in patients post-tuberculosis. Patients with significant kyphosis typically present cosmetic and functional problems related to the biomechanical changes. There are many types of kyphotic deformity corrections, the posterior approach allows bigger degree of correction, but its main problem is neurological deficit during or post-surgery. Therefore, we correct the deformity by performing gradual cantilever bending after vertebral resection. Methods: We present a case: a 31 year-old female diagnosed with severe kyphosis in healed spondylitis tuberculosis. The patient was diagnosed with lung and spine tuberculosis 20 years ago and she was treated with anti-TB drugs for 12 months. Physical examination showed severe kyphotic deformity of 91 degrees. Although the patient did not have any neurological deficit or pain, the patient had difficulty when lying on bed and she also complained about getting easily fatigue, hence she agreed on the correction procedure. The procedure took place at Cipto Mangunkusumo Hospital dated January 24th 2017. The Surgery was performed by an attending spine surgeon, one spine fellow surgeon and two orthopedic residents. The technique used was a modification of posterior approach of vertebral column resection with gradual bending. The length of surgery was 7 hours, with 2100 ml blood loss during the surgery. Results: Pre- and post-operative X-rays was compared with Cobb method, pre-operative X-ray was 91.47o compared to post-operative X ray which was 51.35o. There was no major event observed. The patient was discharged 7 days postoperative without any neurological deficit. Discussion: A single stage posterior approach with posterior column resection could be one choice of treatment in patients with post-tuberculosis kyphosis. The advantages of this single stage approach is reduced possibility of what could occur in a two-stage surgery: extensive blood loss and longer duration of surgery. Conclusion: We conclude that this procedure is an effective and a save method in correcting severe post-tuberculosis kyphosys.