Radical excision and grafting with pedicular fixation for the treatment of tuberculous kyphosis

ABSTRACT

In the last four years, twenty-five cases of tuberculous spondylitis with kyphotic deformity were treated by radical excision operation and transpedicular screw fixation [TPSF]. In eighteen cases, one stage approach, lateral rachotomy, radical excision of the lesion, strut iliac bone graft and TPSF were done. In the remaining seven cases, two stages produced was done. In the first stage, left thoracotomy, anterior radical excision and iliac bone graft were carried out, followed by posterior TPSF as a second stage two weeks later. Before surgery, nine cases were paraplegic, while the remaining sixteen cases were neurologically free. The maximum preoperative angle of kyphosis was 70 degrees, while the minimum was 30 with a mean of 52 degrees. An average correction of 28 degrees of the kyphotic angle was achieved immediately after surgery. A mean loss of 14 degrees of the obtained correction was noticed after an average of 31 months follow up with solid bony fusion of the spinal lesions. All but one of the paraplegic patients showed full neurological recovery. This approach combining internal fixation with debridement-fusion of the spine proved to be effective in correction of tuberculous kyphosis, avoiding increase of the kyphotic deformity and providing sufficient rest and protection during healing of the tuberculous spinal lesion