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Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy.

Abstract

Objective:

This study aimed to evaluate the clinical effects of a posterior surgical strategy for rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis, especially emphasizing the management of adjacent segment degeneration.

Design:

This is a retrospective study.

Setting:

This study was performed at Union Hospital, Tongji Medical College, Wuhan, China

Participants:

A total of 11 patients with rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis were included.

Interventions:

Each patient underwent posterior vertebral column resection (PVCR) for the correction of kyphosis, and mPSO was used for decompression of the stenotic adjacent segments. Outcome measures: Postoperatively, clinical and radiological evaluation was assessed.

Results:

Eight patients underwent PVCR, and 4 patients underwent both the PVCR and mPSO procedures. The average operation time was 6.5 hours (4.5-7.5 hours). The kyphotic angle improved from 97.5 ± 21.3° preoperatively to 45.4 ± 17.2° postoperatively. According to the ASIA grading system, 8 patients recovered to grade E, 2 to grade D, and 1 patient to grade A.

Conclusion:

PVCR is an effective procedure for the correction of rigid angular kyphosis in patients with spinal tuberculosis. Adjacent segment degeneration is an important risk factor for causing neurologic deficits, and posterior surgical management for angular kyphosis of thoracolumbar tuberculosis and spinal decompression using mPSO are recommended.

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  • Authors+Show Affiliations

    ,

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    ,

    b Department of Orthopaedic Surgery , People's Hospital of Macheng City , Huanggang , People's Republic of China.

    ,

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    ,

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    ,

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    ,

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    a Department of Orthopaedic Surgery, Union Hospital, Tongji Medical College , Huazhong University of Science and Technology , Wuhan , People's Republic of China.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31204907

    Citation

    Wu, Xinghuo, et al. "Adjacent Segment Degeneration and Spinal Cord Compression in Rigid Angular Kyphosis of Spinal Tuberculosis and Its Intraoperative Management Strategy." The Journal of Spinal Cord Medicine, 2019, pp. 1-8.
    Wu X, Xiong G, Hua W, et al. Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy. J Spinal Cord Med. 2019.
    Wu, X., Xiong, G., Hua, W., Wang, K., Li, S., Zhang, Y., & Yang, C. (2019). Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy. The Journal of Spinal Cord Medicine, pp. 1-8. doi:10.1080/10790268.2019.1624428.
    Wu X, et al. Adjacent Segment Degeneration and Spinal Cord Compression in Rigid Angular Kyphosis of Spinal Tuberculosis and Its Intraoperative Management Strategy. J Spinal Cord Med. 2019 Jun 17;1-8. PubMed PMID: 31204907.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Adjacent segment degeneration and spinal cord compression in rigid angular kyphosis of spinal tuberculosis and its intraoperative management strategy. AU - Wu,Xinghuo, AU - Xiong,Guang, AU - Hua,Wenbin, AU - Wang,Kun, AU - Li,Shuai, AU - Zhang,Yunkun, AU - Yang,Cao, Y1 - 2019/06/17/ PY - 2019/6/18/entrez KW - Adjacent segment degeneration KW - Kyphosis KW - Posterior vertebral column resection KW - Tuberculosis SP - 1 EP - 8 JF - The journal of spinal cord medicine JO - J Spinal Cord Med N2 - Objective: This study aimed to evaluate the clinical effects of a posterior surgical strategy for rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis, especially emphasizing the management of adjacent segment degeneration. Design: This is a retrospective study. Setting: This study was performed at Union Hospital, Tongji Medical College, Wuhan, China Participants: A total of 11 patients with rigid angular kyphosis in the healed late stage of thoracolumbar tuberculosis were included. Interventions: Each patient underwent posterior vertebral column resection (PVCR) for the correction of kyphosis, and mPSO was used for decompression of the stenotic adjacent segments. Outcome measures: Postoperatively, clinical and radiological evaluation was assessed. Results: Eight patients underwent PVCR, and 4 patients underwent both the PVCR and mPSO procedures. The average operation time was 6.5 hours (4.5-7.5 hours). The kyphotic angle improved from 97.5 ± 21.3° preoperatively to 45.4 ± 17.2° postoperatively. According to the ASIA grading system, 8 patients recovered to grade E, 2 to grade D, and 1 patient to grade A. Conclusion: PVCR is an effective procedure for the correction of rigid angular kyphosis in patients with spinal tuberculosis. Adjacent segment degeneration is an important risk factor for causing neurologic deficits, and posterior surgical management for angular kyphosis of thoracolumbar tuberculosis and spinal decompression using mPSO are recommended. SN - 2045-7723 UR - https://www.unboundmedicine.com/medline/citation/31204907/Adjacent_segment_degeneration_and_spinal_cord_compression_in_rigid_angular_kyphosis_of_spinal_tuberculosis_and_its_intraoperative_management_strategy L2 - http://www.tandfonline.com/doi/full/10.1080/10790268.2019.1624428 DB - PRIME DP - Unbound Medicine ER -