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Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature.
J Orthop Surg Res 2018; 13(1):269JO

Abstract

BACKGROUND

Severe post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications. This study retrospectively evaluates the efficacy and safety of posterior vertebral column resection (PVCR) for treating severe post-tubercular kyphosis with late-onset neurological deficits.

METHODS

From January 2012 to December 2015, 13 patients with severe post-tubercular kyphosis underwent PVCR. All these patients were of late-onset neurological deficits. The operative time, blood loss, preoperative and postoperative kyphotic angles, sagittal vertical axis (SVA), neurological status, and complications were recorded. The preoperative and postoperative Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back pain were compared. The American Spinal Injury Association (ASIA) grading system was used to evaluate neurological function.

RESULTS

The mean postoperative follow-up period was 28.6 months. The mean operative time was 388 ± 46 min. The mean blood loss was 2554 ± 1459 ml. The mean preoperative and postoperative kyphotic angles were 93.7 ± 14.4° and 31.7 ± 7.3°, respectively, with a mean correction of 62.0 ± 13.8°. The mean preoperative and postoperative SVA were 43.2 ± 44.4 mm and 17.8 ± 16.2 mm, respectively. The mean ODI score improved from 56.3 ± 5.1 preoperatively to 18.3 ± 18.5 at last follow-up. The mean VAS score improved from 6.4 ± 1.8 preoperatively to 1.8 ± 0.8 at last follow-up. Two cases had spinal cord injuries, including one complete paraplegia and one incomplete paraplegia, and a total neurological complication rate of 15.4%. The risk factors for neurological complications were summarized.

CONCLUSIONS

Severe post-tubercular kyphosis with late-onset neurological deficits can be corrected by PVCR carefully and properly to prevent neurological complications. In many cases with stenosis adjacent to the angular kyphosis, sufficient decompression of the spinal cord at the segments with stenosis is necessary before correcting the kyphosis.

Authors+Show Affiliations

Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China. yangcao1971@sina.com.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

30367662

Citation

Hua, Wenbin, et al. "Incidence and Risk Factors of Neurological Complications During Posterior Vertebral Column Resection to Correct Severe Post-tubercular Kyphosis With Late-onset Neurological Deficits: Case Series and Review of the Literature." Journal of Orthopaedic Surgery and Research, vol. 13, no. 1, 2018, p. 269.
Hua W, Wu X, Zhang Y, et al. Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature. J Orthop Surg Res. 2018;13(1):269.
Hua, W., Wu, X., Zhang, Y., Gao, Y., Li, S., Wang, K., ... Yang, C. (2018). Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature. Journal of Orthopaedic Surgery and Research, 13(1), p. 269. doi:10.1186/s13018-018-0979-7.
Hua W, et al. Incidence and Risk Factors of Neurological Complications During Posterior Vertebral Column Resection to Correct Severe Post-tubercular Kyphosis With Late-onset Neurological Deficits: Case Series and Review of the Literature. J Orthop Surg Res. 2018 Oct 26;13(1):269. PubMed PMID: 30367662.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Incidence and risk factors of neurological complications during posterior vertebral column resection to correct severe post-tubercular kyphosis with late-onset neurological deficits: case series and review of the literature. AU - Hua,Wenbin, AU - Wu,Xinghuo, AU - Zhang,Yukun, AU - Gao,Yong, AU - Li,Shuai, AU - Wang,Kun, AU - Liu,Xianzhe, AU - Yang,Shuhua, AU - Yang,Cao, Y1 - 2018/10/26/ PY - 2018/07/04/received PY - 2018/10/17/accepted PY - 2018/10/28/entrez PY - 2018/10/28/pubmed PY - 2019/1/30/medline KW - Kyphosis KW - Late-onset neurological deficits KW - Neurological complication KW - Post-tubercular kyphosis KW - Posterior vertebral column resection SP - 269 EP - 269 JF - Journal of orthopaedic surgery and research JO - J Orthop Surg Res VL - 13 IS - 1 N2 - BACKGROUND: Severe post-tubercular kyphosis with late-onset neurological deficits is difficult to treat, with high risk of neurological complications. This study retrospectively evaluates the efficacy and safety of posterior vertebral column resection (PVCR) for treating severe post-tubercular kyphosis with late-onset neurological deficits. METHODS: From January 2012 to December 2015, 13 patients with severe post-tubercular kyphosis underwent PVCR. All these patients were of late-onset neurological deficits. The operative time, blood loss, preoperative and postoperative kyphotic angles, sagittal vertical axis (SVA), neurological status, and complications were recorded. The preoperative and postoperative Oswestry Disability Index (ODI) scores and visual analog scale (VAS) scores for back pain were compared. The American Spinal Injury Association (ASIA) grading system was used to evaluate neurological function. RESULTS: The mean postoperative follow-up period was 28.6 months. The mean operative time was 388 ± 46 min. The mean blood loss was 2554 ± 1459 ml. The mean preoperative and postoperative kyphotic angles were 93.7 ± 14.4° and 31.7 ± 7.3°, respectively, with a mean correction of 62.0 ± 13.8°. The mean preoperative and postoperative SVA were 43.2 ± 44.4 mm and 17.8 ± 16.2 mm, respectively. The mean ODI score improved from 56.3 ± 5.1 preoperatively to 18.3 ± 18.5 at last follow-up. The mean VAS score improved from 6.4 ± 1.8 preoperatively to 1.8 ± 0.8 at last follow-up. Two cases had spinal cord injuries, including one complete paraplegia and one incomplete paraplegia, and a total neurological complication rate of 15.4%. The risk factors for neurological complications were summarized. CONCLUSIONS: Severe post-tubercular kyphosis with late-onset neurological deficits can be corrected by PVCR carefully and properly to prevent neurological complications. In many cases with stenosis adjacent to the angular kyphosis, sufficient decompression of the spinal cord at the segments with stenosis is necessary before correcting the kyphosis. SN - 1749-799X UR - https://www.unboundmedicine.com/medline/citation/30367662/Incidence_and_risk_factors_of_neurological_complications_during_posterior_vertebral_column_resection_to_correct_severe_post_tubercular_kyphosis_with_late_onset_neurological_deficits:_case_series_and_review_of_the_literature_ L2 - https://josr-online.biomedcentral.com/articles/10.1186/s13018-018-0979-7 DB - PRIME DP - Unbound Medicine ER -