20-Year-Follow up of Treatment Using Spine Osteotomy and Halo-pelvic Traction for Tuberculous Kyphosis: A Case Report

A 23-year-old male whose medical history included tuberculous spondylitis presented with a kyphotic deformity and incomplete paraplegia of twenty days duration. Preoperative radiographs demonstrated a T12-L4 kyphotic Cobb's angle of 100degrees with a complete block showing on the lumbar myelogram at L4-5. The patient underwent anterior osteotomy and release. After the operation, a halo-pelvic apparatus was fit onto the patient, and distraction was begun. After distraction for 2 months, posterior osteotomy and release was performed for final correction, and distraction was maintained for another three weeks. Finally, the kyphotic deformity was corrected to a Cobb's angle of 62degrees from T12 to L4. Supplementary anterior fusion was done, and the apparatus was removed after consolidation of the fusion mass.

Shortening procedure : A choice for tuberculous kyphosis correction.

Tuberculous kyphosis is an unstable lesion that tends to progress and lead to many problems.Various corrective osteotomies for kyphosis have been described for various conditions, but not for tuberculosis. This articles proposed shortening procedure to correct tuberculous kyphosis. The preexperimental study was conducted in 49 patients with tuberculous kyphosis treated surgically at Cipto Mangunkusumo and Fatmawati hospital since June 1996 till June 2001. All patients were evaluated radiographically in the preoperative period, postoperative period, and at the latest follow-up (6-36 months). Neurological deficit risk of operation was also evaluated by Frankel grading. The kyphosis were classified into three group, group A (kyphosis 30° - 59°) group B (60° - 89°) and group C (90° - 120°). The average postoperative kyphosis correction was 30.82° (67.5%); in group A 28° (75.49%), in group B 42.3° (62.43%), and in group C 27° (23.36%). Anova test gave significant difference in persentage of postoperative correction. Paired t-test also gave significance postoperative correction in all groups. Neurological complication was found in 6 patients (12.2%); 4 (11,8%) in group A dan 2 (40%) in group C, and no statistical difference between the two groups concerning this complication (p=0.1023). We concluded that shortening procedure for tuberculous kyphosis gave significant correction. In TB-kyphosis > 90° shortening procedure still gave significant correction although a potential risk of serious neurologic complication.

The correction of spinal deformities due to Tuberculous Spondylitis: 6 cases Report / 대한정형외과학회잡지

The Halo-pelvic traction has been considered as a powerful and strong method for correction of the severely deformed rigid spine whether it is kyphotic or scoliotic. It also affords firm stabilization during the operation and postoperative management with immobilization for a long time. Ambulation with this instrument enhances the usefulness. We have succeeded in treating and correcting 6 cases of Tuberculous Kyphosis, and 3 of which accompanied paraplegia. Especially one case of severe kyphosis, 78 was corrected to 20 and anterior strut graft was accomplished with vascuiarized free fibular graft with aid of microvascular technique. The correction rate was 38% in average. No significant complications have developed except osteoporosis of the spine.