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| ZHOU Tianhua,TANG Xun,SU Yongyue.Posterior vertebal column resection for correct severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine[J].Chinese Journal of Spine and Spinal Cord,2014,(1):53-57. |
| Posterior vertebal column resection for correct severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine |
| Received:June 20, 2013 Revised:November 17, 2013 |
| English Keywords:Spinal tuberculosis Post-tubercular kyphosis Posterior vertebral column resection Osteotomy |
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| English Abstract: |
| 【Abstract】 Objectives: To evaluate the safety and efficacy of posterior vertebral column resection in treatment for severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine. Methods: From January 2008 to January 2012, 17 patients with severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine underwent posterior vertebral column resection(PVCR) in our institute. They were 5 males and 12 females, with an average age of 23.6 years old(range, 9 to 40 years). The disease duration ranged from 16 to 122 months(average 37.5 months), two of them underwent debridement through rib-processus transverse approach. One or two vertebral bodies were involved in 8 cases and more than two vertebral bodies were involved in 9 cases. The location of apical vertebrae of angular kyphosis was thoracal spine(T5-T10) in 5 cases, thoracolumbar spine(T11-L1) in 10 cases and lumbar spine in 2 cases. The kyphotic Cobb angle was equal to or larger than 60°, among them 13 cases had Cobb angle betweem 60° to 90°, 4 cases had angle over 90°, with the biggest angle of 102°. All patients had a humpback appearance, no other tuberculosis clinical symptom such as fever or night sweatening was noted. In these cases, kyphotic Cobb angle and ASIA grade were measured before operation, after operation and at final follow-up. Results: All operations were performed successfully. The operation time ranged from 330 to 450min(average, 364min); blood loss during the operation ranged from 1600 to 2500ml(average, 2218ml), and blood transfusion ranged from 1000 to 2000ml(average, 1863ml). Pleura rupture occurred in two cases, and no pneumothorax or hemopneumothorax occurred after repairment. All incisions healed perfectly without sinus formation. No instrument failure or neurological deterioration was noted. The preoperative kyphosis ranged from 60° to 102°(average, 81.3°±12.8°), and postoperative kyphosis ranged from 10° to 28°(average, 17.3°±3.6°), which showed significant difference(P＜0.01). The average kyphosis correction rate was (68.7±6.5)%. The follow-up ranged from 13 to 34 months(average, 18.7 months) and kyphosis at final follow-up ranged from 10° to 32°(average, 20.6°±3.9°), with a loss of correction of 3.3°. Compared with preoperation, these parameters showed significant differences(P＜0.01). Bony union occurred at an average of 6.5 months(range, 4 to 9 months). Among the 5 patients with preoperative ASIA grade D, 4 cases improved to grade E, the other 1 case remained unchanged, but the kyphosis improved and the local back pain relieved very well. Conclusions: Posterior vertebral column resection is an effective and safe way to treat severe focus-healed tubercular angular kyphosis in thoracal and lumbar spine. |
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