Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine

Abstract

Study design: To evaluate the role of single stage decompression with anterior interbody fusion with posterior instrumentation and deformity correction of tuberculous kyphosis of the dorso-lumbar spine in patients with/without neurological deficit.

Objectives: (1) To evaluate the amount of kyphosis correction with single stage surgery and its progression with time. (2) To evaluate the neurological recovery. (3) To evaluate the bony anterior interbody fusion.

Setting: King Edward Memorial Hospital, Bombay, India.

Methods: Twenty-eight patients with post-tuberculous kyphosis deformity averaging 64.3 degrees (range 17 to 105) were treated by a single stage posterolateral decompression, correction of kyphosis, anterior interbody fusion and posterior instrumentation.

Results: The mean kyphosis correction obtained was 62.5% with the mean post-operative kyphosis angle reducing to 24.1 (range 5-60). At a mean follow-up of 5.8 years (4-7 years) the mean kyphosis angle loss was 3.2 degrees (range 0-5 degrees ). Of the 23 patients with neurological deficit, recovery was seen in 21 cases (91.3%) while deterioration was seen in one case (4.3%). The remaining five patients were neurologically intact pre-operatively. Bony fusion was seen in all cases at 9 months. One patient with subpulmonary function died post-operatively (mortality 3.5%).

Conclusion: The results of our series are encouraging. However single stage decompression with fusion and kyphosis correction is a very demanding surgery and should be performed after taking into account the risks and benefits involved. This surgery perhaps prevents progression of neurological deficit and recurrence of late onset paraplegia in these complex cases in developing countries.