title: Kyphotic angle progression of thoracic and thoracolumbar tuberculous spondylitis after surgical treatment: comparison with predicted kyphosis outcome after conservative treatment.
abstract: METHODS
  Retrospective comparative study.
  
  
  OBJECTIVE
  To compare the progression of the kyphotic angle (KA) in a surgically treated group with the predicted outcome of a conservatively treated group.
  
  
  BACKGROUND
  Late onset kyphosis is a complication of tuberculous spondylitis making its prevention a major goal of surgery.
  
  
  METHODS
  Twenty six consecutive patients underwent an anterior reconstruction and posterior instrumented fusion in conjunction with antituberculous chemotherapy. The mean follow up was 56 months (range, 28 to 112 months). The patients were divided into subgroups based on the involved region of the thoracic and the thoracolumbar spine, initial KA, and the initial vertebral body loss (VBL(x)). The predicted KA (KA(Pd)) was calculated using the formula, KA(Pd)=5.5+30.5 VBL(x), to predict the final gibbus deformity. Kyphotic angle progression (DeltaKA) based on the radiographic measurements after surgery (DeltaKA(R)), and the predicted outcome of conservative treatment (DeltaKA(P)) with chemotherapy were compared.
  
  
  RESULTS
  Among the subgroups of the regions involved and initial KA, the DeltaKA was radiographically superior with a reduced amount of kyphogenesis in the surgery group than the predicted outcome of the conservatively treated patients (p<0.05). The radiographic DeltaKA was similar (p>0.05) with VBL(x)</=0.5 in the VBL(x) subgroup.
  
  
  CONCLUSIONS
  These results showed that in the VBL(x) subgroup, an initial VBL(x)</=0.5 is an indication of conservative antituberculous chemotherapy without surgery.
authors.affiliation: Department of Orthopaedic Surgery, The Chungju St. Mary's Hospital, Chungju, Korea.
authors.forename: Soon-Eok
authors.initials: SE
authors.lastname: Kwon
authors.forename: Jae-Hyuk
authors.initials: JH
authors.lastname: Shin
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Na
authors.forename: Yoon-Chung
authors.initials: YC
authors.lastname: Kim
authors.forename: Kee-Yong
authors.initials: KY
authors.lastname: Ha
references.citation: Spine (Phila Pa 1976). 1993 Oct 1;18(13):1890-4
references.pmid: 8235878
references.citation: Int Orthop. 1997;21(1):46-51
references.pmid: 9151184
references.citation: J Bone Joint Surg Br. 2003 Jan;85(1):100-6
references.pmid: 12585586
references.citation: Br J Surg. 1962 Jul;50:26-38
references.pmid: 14458264
references.citation: Spine (Phila Pa 1976). 1995 Sep 1;20(17):1910-6
references.pmid: 8560340
references.citation: J Bone Joint Surg Br. 1982;64(4):393-8
references.pmid: 7047536
references.citation: Clin Orthop Relat Res. 1971 Nov-Dec;81:56-70
references.pmid: 5133045
references.citation: Spine (Phila Pa 1976). 2005 Jan 1;30(1):38-43
references.pmid: 15626979
references.citation: J Bone Joint Surg Br. 1978 May;60-B(2):163-77
references.pmid: 350883
references.citation: Spine (Phila Pa 1976). 2007 Aug 1;32(17):1856-64
references.pmid: 17762293
references.citation: J Bone Joint Surg Br. 1976 Nov;58-B(4):399-411
references.pmid: 1018027
references.citation: J Bone Joint Surg Am. 1989 Oct;71(9):1314-23
references.pmid: 2793883
references.citation: J Bone Joint Surg Br. 1975 Feb;57(1):13-23
references.pmid: 46867
references.citation: Clin Orthop Relat Res. 2002 May;(398):40-9
references.pmid: 11964630
references.citation: J Bone Joint Surg Am. 1987 Apr;69(4):503-9
references.pmid: 3571308
references.citation: Int Orthop. 1995;19(5):327-31
references.pmid: 8567145
references.citation: Int Orthop. 2004 Apr;28(2):110-4
references.pmid: 15224169
references.citation: Clin Orthop Relat Res. 1994 May;(302):173-82
references.pmid: 8168297