Abstract
BackgroundSevere post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications. This study retrospectively evaluates the efficacy and safety of posterior vertebral column resection (PVCR) for treating severe post-tubercular kyphosis with late-onset neurological deficits.MethodsFrom January 2012 to December 2015, 13 patients with severe post-tubercular kyphosis underwent PVCR. All these patients were of late-onset neurological deficits. The operative time, blood loss, preoperative and postoperative kyphotic angles, sagittal vertical axis (SVA), neurological status, and complications were recorded. The preoperative and postoperative Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back pain were compared. The American Spinal Injury Association (ASIA) grading system was used to evaluate neurological function.ResultsThe mean postoperative follow-up period was 28.6 months. The mean operative time was 388 ± 46 min. The mean blood loss was 2554 ± 1459 ml. The mean preoperative and postoperative kyphotic angles were 93.7 ± 14.4° and 31.7 ± 7.3°, respectively, with a mean correction of 62.0 ± 13.8°. The mean preoperative and postoperative SVA were 43.2 ± 44.4 mm and 17.8 ± 16.2 mm, respectively. The mean ODI score improved from 56.3 ± 5.1 preoperatively to 18.3 ± 18.5 at last follow-up. The mean VAS score improved from 6.4 ± 1.8 preoperatively to 1.8 ± 0.8 at last follow-up. Two cases had spinal cord injuries, including one complete paraplegia and one incomplete paraplegia, and a total neurological complication rate of 15.4%. The risk factors for neurological complications were summarized.ConclusionsSevere post-tubercular kyphosis with late-onset neurological deficits can be corrected by PVCR carefully and properly to prevent neurological complications. In many cases with stenosis adjacent to the angular kyphosis, sufficient decompression of the spinal cord at the segments with stenosis is necessary before correcting the kyphosis.
Highlights
Severe post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications
Late-onset neurological deficits or paraplegia usually develops due to the progression of kyphosis, which can be prevented with early stabilization surgery or a combined anterior-posterior procedure or posterior three-column osteotomy [5, 6]
We summarized the clinical efficacy, incidence, and risk factors for neurological complications of posterior vertebral column resection (PVCR) to correct severe post-tubercular kyphosis with late-onset neurological deficits
Summary
Severe post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications. This study retrospectively evaluates the efficacy and safety of posterior vertebral column resection (PVCR) for treating severe post-tubercular kyphosis with late-onset neurological deficits. The major complications of spinal tuberculosis are kyphosis, neurological deficits, or paraplegia. Neurological deficits can be caused by tuberculosis infection and the progression of post-tubercular kyphosis [1]. Early-onset neurological deficits or paraplegia is usually found in the active stages of tuberculosis, which should be treated with chemotherapy and surgery [5]. Late-onset neurological deficits or paraplegia usually develops due to the progression of kyphosis, which can be prevented with early stabilization surgery or a combined anterior-posterior procedure or posterior three-column osteotomy [5, 6]. Late-onset neurological deficits may be related to a lesion cephalad or caudal from the kyphosis [7]
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