title: Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up.
abstract: OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.
authors.affiliation: Department of Spine Surgery, Second Xiangya Hospital of Central South University; and.
authors.forename: Congcong
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Surgery, Xiangya Hospital of Central South University, Changsha, Hunan, China.
authors.forename: Li
authors.initials: L
authors.lastname: Lin
authors.affiliation: Department of Spine Surgery, Second Xiangya Hospital of Central South University; and.
authors.forename: Weixing
authors.initials: W
authors.lastname: Wang
authors.affiliation: Department of Spine Surgery, Second Xiangya Hospital of Central South University; and.
authors.forename: Guohua
authors.initials: G
authors.lastname: Lv
authors.affiliation: Department of Spine Surgery, Second Xiangya Hospital of Central South University; and.
authors.forename: Youwen
authors.initials: Y
authors.lastname: Deng
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000379:methods; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods; D013131:Spine / Q000000981:diagnostic imaging / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D055815:Young Adult
keywords: ASD = adjacent-segment degeneration; ASIA = America Spinal Injury Association; ODI = Oswestry Disability Index; PSI = patient satisfaction index; SVA = sagittal vertical axis; VAS = visual analog scale; VCR = vertebral column resection; long-term outcomes; spine; technique; tuberculosis kyphosis; vertebral column resection