The surgical outcome and complications of posterior correction with vertebral column resection for tuberculotic kyphosis

Abstract

Objective To investigate the outcome and prevention to complications of posterior correction with vertebral column resection for tuberculotic kyphosis. Methods From June 2004 to October 2012, posterior vertebral column resection and correction was performed in 56 patients with tuberculotic kyphosis. The kyphotic apex sited at thoracic segment in 35 cases and thoracolumbar segment in 21 cases. There were fusion deformities of contiguous vertebrae in 53 patients. There were 24 cases with neurological compromise, 7 cases with back pain, 15 cases with both, and 10 cases with no symptom. All the patients underwent vertebral column resection osteotomy with dual axial rotation corrective surgeries. Results The average preoperative kyphosis angle was 87.7°, which decreased to 29.3°after surgery, with an average correction rate of 68.5%. The average follow-up time was 25.3 months, when the average kyphosis angle was 30.9°, with an average correction rate of 66.6% and a loss rate of 2.63%. All the patients' neural functions did not deteriorate, which in detail were 1 case from Frankel A to D, 3 cases from C to D, 14 cases from D to E. The complications included dural tear in 4 cases, nerve root injury in 5 cases, transient neurologic deficit in 4 eases, prosthesis loosening in 1 case, titanium rod breaking in 3 case. All complications got good relief after relevant intervention including dural repair and sew up the incision tightly, methylprednisolone, dehydration or neurotrophic drug treatment, and revision surgery for rebuilding fixation and fusion. The prognosis was desirable. There were no statistical difference about the correction rate and Oswestry dysfunction index (ODI) improvement rate between the complication group (17 cases) and the no complication group (39 cases). Conclusion The outcome of posterior correction with vertebral column resection for tuberculotic kyphosis was delightful while high surgical risk was noted. Intensive monitoring and preventing were recommended at perioperative period. The complications should be treated cautiously, and the results are promising after proper management. Key words: Tuberculosis, osteoarticular; Kyphosis; Vertebroplasty; Postoperative complications