Transpedicular bi‐vertebrae wedge osteotomy in treatment of post‐tubercular spinal deformity: a retrospective study

Abstract 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 and increased risk of neurologic involvement. Spinal osteotomy is thought to be suitable for most patients with severe rigid kyphosis. The aim of this study was to evaluate the efficacy of transpedicular bi-vertebrae osteotomy technique in the patients with Pott’s kyphosis and other post-tubercular spinal deformity. Methods Between January 2012 and December 2015, 18 patients with post-tubercular spinal deformity underwent the transpedicular bi-vertebrae wedge osteotomy, with a minimum follow up of 27.0 months. Preoperative and postoperative kyphotic angle, sagittal plane parameters (TK for thoracic deformity, TLK for thoracolumbar and LL for lumbar deformity) and sagittal vertical axis (SVA) were measured. Oswestry Disability Index (ODI), Visual analog scale (VAS) and modified American Spinal Injury Association grading (ASIA) of preoperative and final follow-up were documented and compared. Results The average operation time was 305 minutes (range, 200–430 minutes) with a mean intraoperative blood loss of 425 mL (range, 200-700 mL). The kyphotic angles decreased from 80.3° (range, 28.5°-130.8°) preoperatively to 26.1° (range, 7.0°-63.3°) at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 5.2(range, 2-9) to 0.9(range, 0-2, P<0.01) and the ODI improved from 55.3% (range, 46%-76%) to 6.3% (range, 2%-18%, 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 7 patients, C to D in 3 patients. Conclusions Our results suggest that transpedicular bi-vertebrae wedge osteotomy is a safe and effective treatment option for post-tubercular spinal deformity. This technique achieves satisfying correction and fusion rates with adequate decompression of neurological elements.

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Transpedicular Bi-vertebrae Wedge Osteotomy in Treatment of Post-tubercular Spinal Deformity: A Retrospective Study

10.21203/rs.3.rs-94003/v1 ◽

2020 ◽

Author(s):

Yi HUANG ◽

Wenhao HU ◽

Jing LI ◽

Tianhao WANG ◽

Huawei LIU ◽

...

Keyword(s):

Spinal Deformity ◽

Sagittal Plane ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Operation Time ◽

Wedge Osteotomy ◽

Osteotomy Site ◽

Bony Destruction ◽

Increased Risk

Abstract 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 and increased risk of neurologic involvement. Spinal osteotomy is thought to be suitable for most patients with severe rigid kyphosis. The aim of this study was to evaluate the efficacy of transpedicular bi-vertebrae osteotomy technique in the patients with Pott’s kyphosis and other post-tubercular spinal deformity.Methods: Between January 2012 and December 2015, 18 patients with post-tubercular spinal deformity underwent the transpedicular bi-vertebrae wedge osteotomy, with a minimum follow up of 27.0 months. Preoperative and postoperative kyphotic angle, sagittal plane parameters (T1-T12 angle for thoracic deformity, T10-L2 angle for thoracolumbar and L1-L5 angle for lumbar deformity) and sagittal vertical axis (SVA) were measured. Oswestry Disability Index (ODI), Visual analog scale (VAS) and modified American Spinal Injury Association grading(ASIA) of preoperative and final follow-up were documented. Results:The average operation time was 455 minutes (range, 200-260 minutes) with a mean intraoperative blood loss of 425 mL (range, 200-700 mL). The kyphotic angles decreased from 80.3° (range, 28.5°-130.8°) preoperatively to 26.1° (range, 7.0°-63.3°) at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 5.2(range, 2-9) to 0.9(range, 0-2, P<0.01) and the ODI improved from 55.3% (range, 46%-76%) to 6.3% (range, 2%-18%, 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 7 patients, C to D in 3 patients.Conclusions:Our results suggest that transpedicular bi-vertebrae wedge osteotomy is a safe and effective treatment option for post-tubercular spinal deformity. This technique achieves satisfying correction and fusion rates with adequate decompression of neurological elements.

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

10.21203/rs.3.rs-27910/v1 ◽

2020 ◽

Author(s):

Wenhao Hu ◽

Huawei Liu ◽

Fangqi Hu ◽

Qi Wang ◽

Teng Li ◽

...

Keyword(s):

Surgical Treatment ◽

Vertebral Column ◽

Thoracic Kyphosis ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Operation Time ◽

Osteotomy Site ◽

Bony Destruction ◽

The Mean

Abstract 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.

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The Natural History of Progression in Adult Spinal Deformity: A Radiographic Analysis

Global Spine Journal ◽

10.1177/2192568219845659 ◽

2019 ◽

Vol 10 (3) ◽

pp. 272-279 ◽

Cited By ~ 2

Author(s):

Sayf S. A. Faraj ◽

Niek te Hennepe ◽

Miranda L. van Hooff ◽

Martin Pouw ◽

Marinus de Kleuver ◽

...

Keyword(s):

Prognostic Factors ◽

Cobb Angle ◽

Spinal Deformity ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Coronal Plane ◽

Historical Cohort ◽

Curve Magnitude ◽

Nonsurgical Patients

Study Design: Historical cohort study. Objective: To evaluate progression in the coronal and sagittal planes in nonsurgical patients with adult spinal deformity (ASD). Methods: A retrospective analysis of nonsurgical ASD patients between 2005 and 2017 was performed. Magnitude of the coronal and sagittal planes were compared on the day of presentation and at most recent follow-up. Previous reported prognostic factors for progression in the coronal plane, including the direction of scoliosis, curve magnitude, and the position of the intercrest line (passing through L4 or L5 vertebra), were studied. Results: Fifty-eight patients were included with a mean follow-up of 59.8 ± 34.5 months. Progression in the coronal plane was seen in 72% of patients. Mean Cobb angle on the day of presentation and most recent follow-up was 37.2 ± 14.6° and 40.8° ± 16.5°, respectively. No significant differences were found in curve progression in left- versus right-sided scoliosis (3.3 ± 7.1 vs 3.7 ± 5.4, P = .81), Cobb angle <30° versus ≥30° (2.6 ± 5.0 vs 4.3 ± 6.5, P = .30), or when the intercrest line passed through L4 rather than L5 vertebra (3.4 ± 5.0° vs 3.8 ± 7.1°, P = .79). No significant differences were found in the sagittal plane between presentation and most recent follow-up. Conclusions: This is the first study that describes progression in the coronal and sagittal planes in nonsurgical patients with ASD. Previous reported prognostic factors were not confirmed as truly relevant. Although progression appears to occur, large variation exists and these results may not be directly applicable to the individual patient.

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A Critical Analysis of Sagittal Plane Deformity Correction with Minimally Invasive Adult Spinal Deformity Surgery: A Two-Year Follow-Up Study

The Spine Journal ◽

10.1016/j.spinee.2015.07.113 ◽

2015 ◽

Vol 15 (10) ◽

pp. S126-S127

Author(s):

International Spine Study Group ◽

Gregory M. Mundis ◽

Jay D. Turner ◽

Vedat Deviren ◽

Juan S. Uribe ◽

...

Keyword(s):

Minimally Invasive ◽

Spinal Deformity ◽

Critical Analysis ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Deformity Correction ◽

Follow Up Study ◽

Spinal Deformity Surgery ◽

Plane Deformity

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Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up

Journal of Neurosurgery Spine ◽

10.3171/2015.8.spine15534 ◽

2016 ◽

Vol 24 (5) ◽

pp. 777-785 ◽

Cited By ~ 8

Author(s):

Congcong Liu ◽

Li Lin ◽

Weixing Wang ◽

Guohua Lv ◽

Youwen Deng

Keyword(s):

Sagittal Balance ◽

Vertebral Column ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Adjacent Segment ◽

Kyphosis Angle ◽

Analog Scale ◽

Vertebral Column Resection

OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.

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How to select the fusion and fixation range of thoracolumbar and lumbar tuberculosis: A retrospective clinical study

10.21203/rs.3.rs-22774/v1 ◽

2020 ◽

Author(s):

Yang zong qiang ◽

Liu chang hao ◽

Niu ning kui ◽

Tang jing ◽

Sayed Abdulla Jami ◽

...

Keyword(s):

Bone Graft ◽

Clinical Efficacy ◽

Clinical Data ◽

Spinal Tuberculosis ◽

Operation Time ◽

Adjacent Vertebral Body ◽

Surgery Group ◽

Surgical Methods ◽

Retrospective Clinical Study

Abstract Purpose To investigate the clinical data of thoracolumbar and lumbar spinal tuberculosis with diseased and non-diseased intervertebral surgery, evaluate the clinical efficacy of the two surgical methods, and explore how to choose the fusion of fixation range. Methods Among 221 patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. 118 patients were in the diseased intervertebral surgery group (lesion vertebral pedicle fixation, group A) and there were 103 patients in the non-diseased intervertebral surgery group (1 or 2 vertebral fixation groups at the above and below levels of the affected vertebra, group B). Both groups of patients were treated with primary or staging, anterior combined complete lesion removal, bone graft fusion, and internal fixation. By analyzing of clinical data and the clinical efficacy of the two surgical methods in thoracolumbar and lumbar tuberculosis was evaluated. Results The mean follow-up duration was 65months (range 50–68 months). There were no significant differences in laboratory examination, VAS scores, and the Cobb angle correction rate and the angle loss, however, significant differences between the two groups in operation time, blood loss, drainage volume, and transfusion, the diseased intervertebral surgery group was significantly better than the non-diseased intervertebral surgery group. Meanwhile, the bone graft was fused entirely at the last follow-up. Conclusion Under the conditions of strictly grasping the indications for surgery, intervertebral surgery for thoracolumbar and lumbar tuberculosis is safe, effective, and feasible, and it can effectively restore its physiological curvature and reduce the degeneration of the adjacent vertebral body.

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Hemivertebra Resection Combined With Wedge Osteotomy for Treatment of Severe Rigid Congenital Kyphoscoliosis in Adolescence

10.21203/rs.3.rs-17556/v1 ◽

2020 ◽

Author(s):

Xinhua Yin ◽

Liang Yan ◽

Baorong He ◽

Ding Jun Hao ◽

Zhongkai Liu

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Operation Time ◽

Radiographic Evaluation ◽

Wedge Osteotomy ◽

Sagittal Imbalance ◽

Operative Blood Loss ◽

Hemivertebra Resection ◽

Questionnaire Score

Abstract Background There was a controversy about surgery approach of severe rigid congenital kyphoscoliosis in adolescence treatment. Aim of the study is to compare the clinical efficacy of surgical treatement by hemivertebra resection (HR) and hemivertebra resection combined with wedge osteotomy (HRWO) for severe rigid congenital kyphoscoliosis in adolescence. Methods Twenty-five patients with severe rigid congenital kyphoscoliosis between Jan 2006 and Dec 2011 were studied in our center. The patients were divided into hemivertebra resection group (group HR) or hemivertebra resection combined with wedge osteotomy group (group HRWO). The clinical and radiographic evaluation in terms of operation time, blood loss, correction rate, fusion time, hospital stay, complications and SRS-24 questionnaire score were compared between Group A and Group B. Results It is obvious that group HR achieved much better results in time of operation time, intra-operative blood loss, and hospital stay than group HRWO (P < 0.05). But meanwhile, group HRWO was significantly better than group HR in the times of coronal Cobb angle, kyphosis, the sagittal imbalance, coronal imbalance and SRS-24 questionnaire score (P < 0.05). There were no significant differences between the two groups in the age, mean flexibility, follow-up time, fusion time, and complications in the last follow-up (P > 0.05). Conclusion The outcomes of follow-up showed that the hemivertebra resection combined with wedge osteotomy approach obtained better clinical outcomes hemivertebra resection surgery. It might be a better surgical treatment for severe rigid congenital kyphoscoliosis in adolescence patients, but it needs longer operation time, more intra-operative blood loss, and extended hospital stay.

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Sagittal Plane Spinal Deformity: Correction Thresholds and Health Related Quality of Life at Two-Years Follow-Up

The Spine Journal ◽

10.1016/j.spinee.2011.08.276 ◽

2011 ◽

Vol 11 (10) ◽

pp. S111-S112

Author(s):

Benjamin Ungar ◽

Frank Schwab ◽

Virginie Lafage ◽

Benjamin Blondel ◽

Justin Smith ◽

...

Keyword(s):

Quality Of Life ◽

Spinal Deformity ◽

Sagittal Plane ◽

Deformity Correction ◽

Health Related Quality ◽

Related Quality ◽

Health Related

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Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

10.21203/rs.2.15859/v1 ◽

2019 ◽

Author(s):

Yongchun Zhou ◽

Weiwei Li ◽

Liqun Gong ◽

Jiao Zhou ◽

Jing Luo

Keyword(s):

Bone Grafting ◽

Spinal Tuberculosis ◽

Operation Time ◽

Anterior Debridement ◽

Thoracic Spinal ◽

Group A ◽

Group B ◽

Posterior Debridement ◽

Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

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Sagittal plane correction in pedicle subtraction osteotomy using the Xia 3 SUK Direct Vertebral Rotation System

Journal of Neurosurgery Spine ◽

10.3171/2013.7.spine121162 ◽

2013 ◽

Vol 19 (4) ◽

pp. 507-514 ◽

Cited By ~ 1

Author(s):

Masahiro Kanayama

Keyword(s):

Spinal Deformity ◽

Surgical Procedure ◽

Vertebral Column ◽

Sagittal Plane ◽

Adult Spinal Deformity ◽

Pedicle Subtraction Osteotomy ◽

Vertebral Rotation ◽

Osteotomy Site ◽

Sagittal Imbalance ◽

Scoliosis Surgery

The Xia 3 SUK Direct Vertebral Rotation (DVR) System was developed for performing the vertebral derotation maneuver in scoliosis surgery. The author applied this device to sagittal plane correction in pedicle subtraction osteotomy for adult spinal deformity. The surgical procedure included 1) preparing secure proximal and distal foundations for correction using mutisegmental pedicle screw-rod fixation (to avoid stress concentration to a specific screw-bone interface), 2) decancellating only the posterior two-thirds of the vertebral column, 3) providing supplemental interbody fusion above and below the osteotomy site (the anterior one-third of the vertebral column and interbody cages serve as an anterior column support and a pivot of correction), 4) closing the osteotomy by gradual approximation of SUK tubes secured to the proximal- and distal-most screw heads, and 5) connecting rods between the proximal and distal screw-rod constructs. Eight consecutive patients with fixed sagittal imbalance were treated using this surgical procedure. No patient required distal fixation points extending to the sacrum and/or pelvis. The sagittal plane correction was 43°. The mean anterior deviation of the C-7 plumb line was improved from 12.7 cm to 4.0 cm immediately after surgery, and it was 6.0 cm at the final follow-up. A pedicle subtraction osteotomy using the Xia 3 SUK DVR System ensures a safe and secure sagittal plane correction in adult spinal deformity.

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