title: Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis.
abstract: BACKGROUND
  Very less literature focuses on the treatment of kyphosis in healed stages of spinal tuberculosis (TB), especially in children. The purpose of this study was to evaluate the outcomes of anterior release, decompression, deformity correction, and instrumented fusion, followed by posterior osteotomy, deformity correction, and pedicle screw instrumented fusion, which is used to treat kyphosis in children in healed stages of spinal TB.
  
  
  METHODS
  Sixteen children with kyphotic deformity of the spine in healed stages of TB underwent anterior release, decompression, deformity correction, and instrumented fusion, followed by posterior osteotomy, deformity correction, and pedicle screw instrumented fusion between 2003 and 2007 with at least 2 years of follow-up. Radiologic assessment including the angle of kyphosis and scoliosis, and neurologic status using the modified Frankel grade were analyzed before surgery, after surgery, and at the last follow-up. Fusion was evaluated on flexion-extension lateral radiographs.
  
  
  RESULTS
  Good cosmetic results were achieved in all patients. Neurologic improvement was shown in all 4 patients with paraplegia. The mean preoperative angle of kyphosis was 55.8 degrees that reduced to 21.7 degrees, postoperatively. The difference in the mean angle of kyphosis was statistically significant (P<0.05). The mean angle of kyphosis at the last follow-up was 23.2 degrees. The mean correction loss was 1.5 degree, and there was no statistically significant difference in the mean angles of kyphosis between the postoperative and last follow-up measurements. The mean preoperative angle of scoliosis was 6.9 degrees that reduced to 0.8 degree postoperatively. The difference in the mean angle of scoliosis was statistically significant (P<0.05). The mean angle of scoliosis at the last follow-up was 0.9 degree. The mean correction loss was 0.2 degree and there was no statistically significant difference in the mean angles of scoliosis between the postoperative and last follow-up measurements. All patients returning for follow-up had bony fusion. There were no cases of failure of fixation.
  
  
  CONCLUSIONS
  Combined anterior and posterior osteotomy, deformity correction, and instrumented fusion halted progression of kyphosis and improved neurologic symptoms.
  
  
  METHODS
  Therapeutic-level IV, retrospective study.
authors.affiliation: Department of Orthopedics, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Chunguang
authors.forename: Liu
authors.initials: L
authors.lastname: Limin
authors.forename: Chen
authors.initials: C
authors.lastname: Rigao
authors.forename: Song
authors.initials: S
authors.lastname: Yueming
authors.forename: Liu
authors.initials: L
authors.lastname: Hao
authors.forename: Kong
authors.initials: K
authors.lastname: Qingquan
authors.forename: Gong
authors.initials: G
authors.lastname: Quan
authors.forename: Li
authors.initials: L
authors.lastname: Tao
authors.forename: Zeng
authors.initials: Z
authors.lastname: Jiancheng
mesh_terms: D000293:Adolescent; D002648:Child; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery*; D008297:Male; D010027:Osteotomy / Q000379:methods*; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications*