A new surgical treatment for post-tubercular thoracic kyphosis, a retrospective study.

Background: In the late stage of Spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations. Deformity more commonly occurs and rapidly progresses in the thoracic spine. The surgical treatment of deformity in the thoracic region poses a challenge to the spine surgeon because its high neurological risk. Vertebral column decancellation，a new spinal osteotomy technique, is thought to be suitable for most patients with severe rigid kyphosis. In the current study, we report VCD technique as another surgical strategy for correction of post-tubercular thoracic kyphosis and evaluate the clinical and radiographic patient results.Methods: Between January 2016 and January 2018, 16 patients with post-tubercular thoracic kyphosis underwent the Vertebral column decancellation. Preoperative and postoperative Konstam’s angle were measured. Oswestry Disability Index(ODI) ,Visual analog scale(VAS) and American Spinal Injury Association(ASIA) were documented. The mean follow-up was 31.4 months Results: The average operation time was 226 minutes (range, 200–260 minutes) with a mean intraoperative blood loss of 466 mL (range, 400–580 mL).The Konstam’s angles decreased from 88.8°(range, 76°–103°)preoperatively to 19.0°(range, 9°–32°)at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 7.0(range, 6–8) to 1.7 (range, 1–3, P<0.01) and the ODI improved from 67.6% (range, 59%–77%) to 20.7% (range, 15%–33%, P<0.01). At final follow-up, there was radiographic evidence of solid fusion at the osteotomy site and fixed segments in all patients. Neurological function improved from ASIA scale D to E in 6 patients, C to D in 3 patients.Conclusion: Our results suggest that VCD is a safe and effective treatment option for post-tubercular thoracic kyphosis. This technique achieves higher correction and fusion rates with adequate decompression of neurological elements.

背景：在脊柱结核晚期，骨质破坏和椎体塌陷常导致明显的后凸畸形，临床上表现为疼痛性驼背畸形，伴有稳定性下降和椎体移位。畸形更常见于胸椎且进展迅速。胸椎区域畸形的手术治疗对脊柱外科医生来说是一项挑战，因为其神经风险较高。脊柱去松质骨术，一种新的脊柱截骨技术，被认为适用于大多数严重僵硬性后凸畸形患者。在本研究中，我们报告脊柱去松质骨术作为另一种矫正结核后胸椎后凸畸形的手术策略，并评估患者的临床和影像学结果。 方法：2016年1月至2018年1月，16例结核后胸椎后凸畸形患者接受了脊柱去松质骨术。测量术前和术后的康斯塔姆角。记录奥斯维斯残疾指数（ODI）、视觉模拟评分（VAS）和美国脊柱损伤协会（ASIA）分级。平均随访31.4个月。 结果：平均手术时间为226分钟（范围，200 - 260分钟），平均术中失血量为466 mL（范围，400 - 580 mL）。康斯塔姆角从术前的88.8°（范围，76° - 103°）下降到末次随访时的19.0°（范围，9° - 32°）（P < 0.01）。平均VAS评分从术前的7.0（范围，6 - 8）降低到1.7（范围，1 - 3，P < 0.01），ODI从67.6%（范围，59% - 77%）改善到20.7%（范围，15% - 33%，P < 0.01）。在末次随访时，所有患者的截骨部位和固定节段均有影像学上的坚固融合证据。6例患者神经功能从美国脊柱损伤协会分级D级改善到E级，3例从C级改善到D级。 结论：我们的结果表明，脊柱去松质骨术是治疗结核后胸椎后凸畸形的一种安全有效的治疗选择。该技术在对神经结构充分减压的情况下，实现了较高的矫正率和融合率。