title: [Surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia].
abstract: OBJECTIVE
  To explore an method and the effectiveness of surgical treatment of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity (Cobb angle ≥ 55°) and paraplegia.
  
  
  METHODS
  Between January 2009 and January 2013, 13 cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia were treated by one-stage posterior vertebral column resection (PVCR), debridement, bone grafting, and instrumentation fixation. Of 13 patients, 7 were male and 6 were female with an average age of 23.5 years (range, 14-49 years). The disease duration was 13-38 months (mean, 19 months). The Cobb angle of kyphosis was (65.23 ± 7.95)°. The visual analogue scale score (VAS) was 7.38 ± 0.31. In 13 patients with incomplete paraplegia, 1 case was classified as Frankel grade B, 7 cases as grade C, and 5 cases as grade D. The lesion involved 2 vertebrae bodies in 7 cases (T8, 9 in 1 case, T11, 12 in 2 cases, and T12, L1 in 4 cases), 3 vertebrae bodies in 4 cases (T10-12 in 2 cases, T9-11 in 1 case, and T11-L1 in 1 case), and 4 vertebrae bodies in 2 cases (T4-7 in 1 case and T6-9 in 1 case). Imaging examination showed paravertebral abscess in 10 cases.
  
  
  RESULTS
  Healing of incision by first intention was obtained in all patients. The neurological injury and pulmonary infection occurred in 3 cases and 2 cases respectively, which were cured after symptomatic treatment. Thirteen patients were followed up 12-48 months (mean, 17 months). The erythrocyte sedimentation rate restored to normal level in all cases at 3-7 months after operation. All the patients achieved bony fusion at 10-20 months (mean, 14 months) after operation. No fixation loosening, displacement, or fracture occurred during follow-up. Common toxic symptom of tuberculosis disappeared, and there was no recurrence of local tuberculosis. The Cobb angle of kyphosis was corrected to (22.38 ± 1.76)° at 1 week and (22.15 ± 1.83)° at last follow-up, showing significant difference when compared with preoperative one (P < 0.05). There was no significant difference in Cobb angle of kyphosis between at 1 week after operation and at last follow-up (P > 0.05). The Frankel grading was grade B in 1 case, grade C in 10 cases, and grade D in 2 cases at 1 week after operation; and it was grade D in 1 case and grade E in 12 cases at last follow-up; significant differences were found between at pre- and post-operation (P < 0.05), and between at 1 week after operation and at last follow-up (P < 0.05). The VAS score was 4.08 ± 0.76 at 1 week and 0.62 ± 0.14 at last follow-up, showing significant differences between at pre- and post-operation (P < 0.05) and between at 1 week after operation and at last follow-up (P < 0.05).
  
  
  CONCLUSIONS
  One-stage PVCR, debridement, bone grafting, and instrumentation fixation is proved to be successful in treating thoracic and lumbar tuberculosis complicated with severe kyphotic deformity and paraplegia.
authors.forename: Jiang
authors.initials: J
authors.lastname: Hu
authors.forename: Yue
authors.initials: Y
authors.lastname: Wang
authors.forename: Zhongqian
authors.initials: Z
authors.lastname: Liu
authors.forename: Liuyi
authors.initials: L
authors.lastname: Tang
authors.forename: Lun
authors.initials: L
authors.lastname: Wan
authors.forename: Yaoming
authors.initials: Y
authors.lastname: Zhang
authors.forename: Juncai
authors.initials: J
authors.lastname: Deng
mesh_terms: D016025:Bone Transplantation / Q000379:methods*; D003646:Debridement; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone; D006801:Humans; D007738:Kyphosis / Q000150:complications*; D008159:Lumbar Vertebrae; D008161:Lumbosacral Region; D008297:Male; D010264:Paraplegia / Q000150:complications*; D011184:Postoperative Period; D019651:Plastic Surgery Procedures; D012720:Severity of Illness Index; D013123:Spinal Fusion; D013131:Spine; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000601:surgery*