title: Posterior Vertebral Column Resection With Intraoperative Manual Retraction for the Treatment of Posttubercular Kyphosis in Upper Thoracic Spine or Cervicothoracic Junction.
abstract: METHODS
  This is a case-series.
  
  
  OBJECTIVE
  To evaluate the clinical and radiologic outcomes of posterior vertebral column resection (PVCR) for treatment of posttubercular kyphosis in upper thoracic spine and cervicothoracic junction (CTJ).
  
  
  BACKGROUND
  Surgical management of severe posttubercular kyphosis in upper thoracic spine or CTJ is challenging. A new technique that combines PVCR and intraoperative manual traction in a single procedure, was developed to maximize the correction rate and minimize the risk of dural buckling and spinal cord injury. However, the safety and effectiveness of the procedure is yet to be established.
  
  
  METHODS
  Ten patients with upper thoracic or CTJ posttubercular kyphosis, who underwent PVCR with intraoperative manual traction between December 2008 and 2013, were studied retrospectively. Data pertaining to operation time, blood loss, and perioperative complications were collected. Outcomes were evaluated using the visual analog scale; the 12-Item Short Form Health Survey (SF-12), Mental Component Summary, and SF-12 Physical Component Summary. Neurological status was assessed using American Spinal Injury Association (ASIA) impairment scale. Radiologic outcomes including fusion and deformity correction were assessed using plain radiography and computed tomography.
  
  
  RESULTS
  The average duration of follow-up was 53.6±7.2 months. Average operating time and blood loss were 263±35.3 minutes and 2490±569 mL, respectively. Visual analog scale score for back pain, SF-12 Mental Component Summary, and Physical Component Summary showed significant improvement postoperatively. Kyphosis improved from a preoperative average of 73.6±13.1 degrees to an average of 37.9±8.7 degrees at final follow-up (correction rate: 48.5%). No postoperative neurological deterioration was observed based on the ASIA score. As of the last follow-up, solid fusion was not achieved only in 1 patient.
  
  
  CONCLUSIONS
  PVCR with intraoperative manual traction is a safe and effective procedure for treatment of upper thoracic or CTJ posttubercular kyphosis.
  
  
  METHODS
  Level 4.
authors.affiliation: Department of Spinal Surgery, The Second Xiangya Hospital of Central South, University, Changsha, Hunan Province, China.
authors.forename: Yuqiao
authors.initials: Y
authors.lastname: Chen
authors.forename: Guohua
authors.initials: G
authors.lastname: Lü
authors.forename: Bing
authors.initials: B
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Li
authors.forename: Lei
authors.initials: L
authors.lastname: Kuang
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D007738:Kyphosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D008297:Male; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D014399:Tuberculosis, Spinal / Q000150:complications* / Q000000981:diagnostic imaging