The use of posterior vertebral column resection in the management of severe posttuberculous kyphosis: a retrospective study and literature review

Abstract

We present a retrospective study of 15 cases with severe posttuberculous kyphosis of thoracolumbar region that underwent posterior vertebral column resection. From 2004 to 2009, 15 consecutive patients with posttubercular kyphotic deformity underwent posterior vertebral resection osteotomy. Six subjects were females and nine were males with an average age of 35.8years (range 20-60years) at the time of surgery. None of the patients had neurological deficits. The mean preoperative visual analogue scale was 8.7 (range 3-9), and the average preoperative Oswestry Disability Index was 46.5 (range 40-56). The average duration of postoperative follow-up was 36.1±10.7months (range 24-62months). The number of vertebra resected was 1.3 (range 1-2) on average. There were ten patients with one-level osteotomy and five patients with two-level osteotomy. The average operation time was 446.0±92.5min (range 300-640min) with an average blood loss of 1,653.3±777.9ml (range 800-3000ml). The focal kyphosis before surgery averaged 92.3±8.9° (range 74-105°), and the kyphotic angle decreased to 34.5±8.7° on average after the surgical correction. The average kyphotic angle at the last follow-up was 36.9±8.5°, loss of correction was 2.4±1.4° on average. All patients postoperatively received bony fusion within 6-9months. Our results showed that although posterior vertebral resection is a highly technical procedure, it can be used safely and effectively in the management of severe posttuberculous kyphosis. It is imperative that operations be performed by an experienced surgical team to prevent operation-related complications.