title: Late treatment of tuberculosis-associated kyphosis: literature review and experience from a SRS-GOP site.
abstract: BACKGROUND
  Spinal tuberculosis (TB) accounts for approximately half of all cases of musculoskeletal tuberculosis. Kyphosis is the rule in spinal tuberculosis and has potential detrimental effects on both the spinal cord and pulmonary function. Late-onset paraplegia is best avoided with the surgical correction of severe kyphosis, where at the same time anterior decompression of the cord is performed and the remnants of the tuberculosis-destroyed vertebral bodies are excised.
  
  
  METHODS
  Review of the literature on late surgical treatment of TB-associated kyphosis; description and comparative analysis of the different surgical techniques.
  
  
  RESULTS
  Kyphosis can be corrected either at the acute stage or at the healed late stage of tuberculous infection. In the late stage, the stiffness of the spine and chronic lung disease are additional considerations for the surgical approach and technique. Contrary to the traditional anterior transpleural approach used in the acute spinal tuberculosis infection, extrapleural approaches, either antero-lateral or direct posterior, are favored in late treatment.
  
  
  CONCLUSIONS
  The correction of deformity is only feasible with three-column osteotomies, and posterior vertebral column resection (PVCR) is the treatment of choice in extreme kyphosis. The prognosis of the neurologic deficit (late paraplegia) is dependent on the extent of gliosis of the spinal cord.
authors.affiliation: Foundation of Orthopedics and Complex Spine, 523 East, 72nd Street, New York, NY 10021, USA.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Elias C
authors.initials: EC
authors.lastname: Papadopoulos
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Cunningham
authors.forename: Francisco Sanchez
authors.initials: FS
authors.lastname: Perez-Grueso
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.forename: Baron
authors.initials: B
authors.lastname: Lonner
authors.forename: Kenneth
authors.initials: K
authors.lastname: Paonessa
authors.forename: Akilah
authors.initials: A
authors.lastname: King
authors.forename: Cristina
authors.initials: C
authors.lastname: Sacramento
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Michael
authors.initials: M
authors.lastname: Mendelow
authors.forename: Muharrem
authors.initials: M
authors.lastname: Yazici
mesh_terms: D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007738:Kyphosis / Q000209:etiology* / Q000601:surgery*; D010264:Paraplegia / Q000209:etiology / Q000517:prevention & control; D013123:Spinal Fusion / Q000379:methods*; D014399:Tuberculosis, Spinal / Q000150:complications*