title: Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the clinical and radiographic outcomes of modified pedicle subtraction osteotomy (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients.
  
  
  METHODS
  From January 2008 to August 2012, 26 consecutive pediatric patients with thoracolumbar post-tubercular kyphosis underwent modified pedicle subtraction osteotomy (mPSO). The clinical and radiologic outcomes were analyzed preoperatively, postoperatively, and at the last follow-up.
  
  
  RESULTS
  Twenty-six patients with thoracolumbar post-tubercular kyphosis underwent mPSO. The average operation time was 256 min (188~314 min). The mean follow-up was 41 months (18~56 months). The mean estimated blood loss was 870 ml (620 ~ 1020 ml). The thoracolumbar kyphotic angle ranged from 51° to 79° before operation, 60.6° in average. The mean thoracolumbar kyphotic Cobb angle was 19.7° after operation, with a mean correction of 40.9°. The C7 sagittal plumb line was 3.8 cm after operation, comparing to the 10.5 cm preoperative. The mean preoperative angle of thoracic kyphosis (TK) was 9.9° ± 1.2° and increased to 11.8° ± 1.4°, postoperatively. Lumbar lordosis (LL) improved from -22.8° ± 4.9° preoperative to -17.8° ± 2.1° postoperative. Visual analogue scale (VAS) was 8.7 ± 1.1 preoperative and 1.2 ± 0.4 postoperative, respectively. The mean Oswestry Disability Index (ODI) improved from 49.2 ± 5.3 before surgery to 10.8 ± 3.3 postoperative (P < 0.01). All patients received good bone healing, no significant loss of correction angle. Most patients (24/26) considered pain and exterior was significantly improved.
  
  
  CONCLUSIONS
  Modified pedicle subtraction osteotomy (mPSO) is effective and reliable for thoracolumbar post-tubercular kyphosis in pediatric patients.
authors.affiliation: Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China, zhq9996@163.com.
authors.forename: Zhang
authors.initials: Z
authors.lastname: Hong-Qi
authors.forename: Chen
authors.initials: C
authors.lastname: Yong
authors.forename: Huang
authors.initials: H
authors.lastname: Jia
authors.forename: Guo
authors.initials: G
authors.lastname: Chaofeng
authors.forename: Hu
authors.initials: H
authors.lastname: Xiongke
mesh_terms: D000293:Adolescent; D002648:Child; D003029:Coagulants / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D010027:Osteotomy / Q000379:methods*; D010147:Pain Measurement; D011182:Postoperative Care / Q000379:methods; D012189:Retrospective Studies; D012544:Scheuermann Disease / Q000209:etiology* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications*; D014812:Vitamin K / Q000627:therapeutic use
chemical_list: D003029:Coagulants; D014812:Vitamin K