title: Use of Intramedullary K-Wire to Enhance Fibular Graft Placement in 4-Level Thoracolumbar Corpectomy for Pott Disease: Case Report and Review of Literature.
abstract: Reports of tuberculosis involving ≥4 contiguous spinal levels are rare. Surgery is often required in this population for neurological decompression and stabilization. These patients appear to be particularly predisposed to complications that include incomplete recovery of neurological function after decompression as well as post-treatment kyphosis. In settings with limited available instrumentation, reconstruction of the anterior column can be challenging.
  
  
  
  A 35-year-old woman presented with back pain, progressive weakness in her bilateral lower extremities, and inability to walk for 2 months. Imaging demonstrated anterior destruction of T10, T11, T12, and L1 with severe retropulsion and cord impingement at T11-T12. The patient was taken for anterolateral corpectomies of T10-L1 with decompression of the thoracic spinal cord and fibular strut autograft placement followed by a T8 to L3 posterior spinal fusion. An intramedullary Kirschner-wire (K-wire) was placed during the anterolateral procedure to enhance fibular graft placement and prevent dislodgement before definitive posterior fusion.
  
  
  
  At follow-up five-and-a-half months after the operation, the patient had recovered full strength and was ambulating without difficulty. Imaging at this time demonstrated stable restoration of alignment without graft dislodgement. Intramedullary fibular K-wire placement in this procedure helped to optimize anterior column reconstruction. The principles used in this report may prove beneficial to surgeons in developing countries who encounter pathology of this extent.
authors.affiliation: Department of Neurological Surgery, David Grant Medical Center, Travis Air Force Base, California, USA. Electronic address: jonathan.a.forbes@gmail.com.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Forbes
authors.affiliation: Department of Cardiothoracic Surgery, David Grant Medical Center, Travis Air Force Base, California, USA.
authors.forename: Jason
authors.initials: J
authors.lastname: Williams
authors.affiliation: Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
authors.forename: Ahmed J
authors.initials: AJ
authors.lastname: Awad
authors.affiliation: Department of Anesthesiology, David Grant Medical Center, Travis Air Force Base, California, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Tiger
authors.affiliation: Department of Orthopedic Surgery, U.S. Air Force Academy, Colorado Springs, Colorado, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Anderson
authors.affiliation: Department of Orthopedic Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA.
authors.forename: Ryan
authors.initials: R
authors.lastname: Finnan
mesh_terms: D000328:Adult; D001864:Bone Wires; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D013117:Spinal Cord Compression / Q000601:surgery; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013904:Thoracic Vertebrae / Q000601:surgery*; D014182:Transplantation, Autologous / Q000295:instrumentation / Q000379:methods; D014399:Tuberculosis, Spinal / Q000000981:diagnostic imaging / Q000601:surgery*
keywords: Fibular autograft; Graft kickout; Pott disease; Thoracolumbar corpectomy