The surgical treatment and related management for post-tubercular kyphotic deformity of the cervical spine or the cervico-thoracic spine

Abstract

Purpose: The outcomes of surgical treatment and related complications of post-tubercular kyphotic (PTK) deformity of the cervical spine or the cervico-thoracic spine were evaluated.

Methods: From January 2005 to October 2010, 12 cases with PTK (7 males, 5 females) with an average age of 30 years (range 21-43 years) formed the study group. There were ten patients with cervical deformities and two with cervico-thoracic kyphosis. Neurological function of all the patients was evaluated by the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score. Two patients with severe cervico-thoracic deformity received modified skeleton traction pre-operatively. Ten patients underwent anterior debridement and reconstruction, using iliac crest or cages with autografts, while two patients with cervico-thoracic kyphosis received posterior instrumentation and fusion.

Results: The mean pre-operative focal kyphotic angle was 42.58° (range 30-67°), reducing to -8° (range -15-11°) postoperatively (at the last follow-up visit). The average operating time was 117.50 min (80-200 min) with an average blood loss of 110 ml (range 50-300 ml). Neurological assessment of all the patients, using the Japanese Orthopaedic Association (JOA) score and visual analogue scale (VAS) score, was improved significantly after surgery. All patients had solid fusion and no major complication was observed in the follow-up.

Conclusion: One-stage anterior debridement, instrumentation and fusion for cervical spinal TB and single posterior instrumentation for cervico-thoracic spinal TB followed by chemotherapy is practical to correct PTK. The procedure has the advantage of lower blood loss, effective kyphosis correction and minimal complications. To patients with severe deformity, skeletal traction seemed indispensible.

Fig. 1

a, b A 22-year-old male patient with cervical kyphosis caused by tuberculosis underwent anterior decompression and correction. A corpectomy was performed followed by autograft transplantion and cervical plate fixation. The lateral view of X-ray film at last follow-up showed satisfactory correction of the deformity and solid fusion of operative segments. c, d The patient was a middle-aged female, demonstrating C4\5 collapse and cervical kyphotic deformity. After removal of diseased vertebra and completed debridement, a titanium mesh associated autograft was placed in site followed by anterior plate stabilization. The last follow-up witnessed solid fusion, and good sagittal alignment of cervical spine was restored

Fig. 2

A 43-year-old female had experienced progressive cervicothoracic kyphosis for 5 years before surgery. MRI (a) and CT scan (b) found severe kyphotic deformity at the junction area of cervicothoracic spine. The symptoms of the patient including severe pain and moderate neurologic deficits at four extremities (JOA 6). Posterior decompression and lateral mass screw and pedicle screw fixation was performed to achieve the satisfied correction of the deformity. The patient achieved realignment of saggital plane of cervical spine as well as significant pain relief and improvement of neurologic function (JOA 10)