One-stage posterior wedge osteotomy for correction of kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis / 中华骨科杂志

ABSTRACT

Objective To evaluate the efficacy and safety of one-stage posterior wedge osteotomy ffor correction ot kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Methods From January 2002 to December 2012,we retrospectively reviewed 18 patients with tuberculosis of the spine in healed stages which underwent one-stage posterior wedge osteotomy.There were 6 males and 12 females,whose average age was 8.2 (4 to 15) years and average followed-up time was 37.1 (10 to 120) months.The apical vertebrae were located at cervicothoracic segment in 2 cases,thoracic segment in 10 cases,thoracolumbar segment in 5 cases and lumbar segment in 1 case.The lesions involved 2 segments in 3 cases,3 to 5 segments in 9 cases and more than 5 segments in 6 cases.There were 6 cases with neurological dysfunction whose Frankel' s classification was C in 2 cases and D in 4 cases.The coronal and sagittal Cobb angels,thoracic kyphosis,lumbar lordosis,sagittal trunk shifts,number of fixation and fusion segments and bony union were measured on the standing AP and lateral radiographs before,after surgery and at the final follow-up.Results The Cobb' s angels in the sagittal plane were corrected from 71.6° to 14.5°,representing 79.7％ correction rate.The Cobb' s angels in the coronal plane were corrected from 9.4° to 0.7°.Sagittal trunk shift was obviously improved from 3.7mm to 0.5mm.The average fixation segment was 9.6 (5 to 17) segments while the average fusion segment was 4.4 (2 to 8) segments.The neurological function had all been improved at final follow-up.Perioperative complications consisted of fixation loosening in 4 cases,gastrointestinal dysfunction in 2 cases,pleura injury in 5 cases,and cerebrospinal fluid leakage in 3 cases.Conclusion One-stage posterior wedge osteotomy is a safe and effective surgical technique for correction of kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Both the selection of fusion levels and the appropriate technique of osteotomy are crucial to good outcomes.