title: Kyphosis secondary to tuberculosis osteomyelitis as a cause of ventilatory failure. Clinical features, mechanisms, and management.
abstract: OBJECTIVE
  To investigate the relationship of thoracic kyphosis following tuberculosis to the development of ventilatory failure and to assess the efficacy on nocturnal noninvasive ventilatory support.
  
  
  METHODS
  Retrospective consecutive case series with crossover from a phase without noninvasive ventilatory support to a phase with this treatment.
  
  
  METHODS
  The Respiratory Support and Sleep Centre, Papworth, Hospital, Cambridge, England.
  
  
  METHODS
  Seven patients with thoracic kyphosis following tuberculous osteomyelitis which had been contracted by the age of 4 years were studied. Their mean age was 53 (SD 7.1) years and the mean angle of kyphosis was 113.60. All patients were in ventilatory failure.
  
  
  METHODS
  The patients were treated with nocturnal noninvasive ventilation with either an individually constructed cuirass shell and a negative pressure pump or nasal intermittent positive pressure ventilation using a volume preset ventilator.
  
  
  RESULTS
  Each patient underwent an initial clinical assessment along with radiologic studies of the spine, pulmonary function tests, daytime arterial blood gas tensions, and overnight recordings of arterial saturation, and transcutaneous carbon dioxide tension. They were reassessed in detail at a mean of 5 years after starting ventilatory support. Symptoms, vital capacity, daytime carbon dioxide tension, and overnight oximetry had all improved following treatment. Temporary withdrawal of ventilatory support led to severe sleep fragmentation in four patients and the appearance of central apneas and hypopneas in the other three. Six of the 7 patients were alive at a mean of 5.7 years after starting nocturnal ventilation.
  
  
  CONCLUSIONS
  These results show that ventilatory failure may develop, after an interval of many years, in patients with a severe thoracic kyphosis due to tuberculosis in childhood. Noninvasive nocturnal ventilatory support can control the symptoms of ventilatory failure, improve the physiologic abnormalities, and is associated with prolonged survival.
authors.affiliation: Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, England.
authors.forename: I E
authors.initials: IE
authors.lastname: Smith
authors.forename: C M
authors.initials: CM
authors.lastname: Laroche
authors.forename: S A
authors.initials: SA
authors.lastname: Jamieson
authors.forename: J M
authors.initials: JM
authors.lastname: Shneerson
mesh_terms: D005260:Female; D006801:Humans; D007738:Kyphosis / Q000150:complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications*; D011175:Positive-Pressure Respiration; D012129:Respiratory Function Tests; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D013997:Time Factors; D014394:Tuberculosis, Osteoarticular / Q000150:complications*