Current status of surgical treatment for angular kyphosis in spinal tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHENG Shuxin , SONG Yueming ,  WANG Lei , ZHENG Shuxin , SONG Yueming ,  WANG Lei

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P. R. China;

Corresponding author：

WANG Lei, Email: wanglei_cd@126.com; WANG Lei, Email: wanglei_cd@126.com

Keywords：

Spinal tuberculosis; angular kyphosis; surgical treatment

DOI：

10.7507/1002-1892.202311059

Video：

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Objective To review current status of surgical treatment for angular kyphosis in spinal tuberculosis and provide reference for clinical treatment. Methods The literature on the surgical treatment for angular kyphosis of spinal tuberculosis in recent years was extensively reviewed and summarized from the aspects of surgical indications, surgical contraindications, surgical approach, selection of osteotomy, and perioperative management. Results Angular kyphosis of spine is a common complication in patients with spinal tuberculosis. If kyphosis progresses gradually, it is easy to cause neurological damage, deterioration, and delayed paralysis, which requires surgical intervention. At present, surgical approaches for angular kyphosis of the spine include anterior approach, posterior approach, and combined anterior and posterior approaches. Anterior approach can be performed for patients with severe spinal cord compression and small kyphotic Cobb angle. Posterior approach can be used for patients with large kyphotic Cobb angle but not serious neurological impairment. A combined anterior and posterior approaches is an option for spinal canal decompression and orthosis. Osteotomy for kyphotic deformity include Smith-Peterson osteotomy (SPO), pedicle subtraction osteotomy (PSO), vertebral column resection(VCR), vertebral column decancellation (VCD), posterior vertebral column resection (PVCR), deformed complex vertebral osteotomy (DCVO), and Y-shaped osteotomy. SPO and PSO are osteotomy methods with relatively low surgical difficulty and low surgical risks, and can provide 15°-30° angular kyphosis correction effect. VCR or PVCR is a representative method of osteotomy and correction. The kyphosis correction can reach 50° and is suitable for patients with severe angular kyphosis. VCD, DCVO, and Y-shaped osteotomy are emerging surgical techniques in recent years. Compared with VCR, the surgical risks are lower and the treatment effects also improve to varying degrees. Postoperative recovery is also a very important part of the perioperative period and should be taken seriously. Conclusion There is no consensus on the choice of surgical treatment for angular kyphosis in spinal tuberculosis. Osteotomy surgery are invasive, which is a problem that colleagues have always been concerned about. It is best to choose a surgical method with less trauma while ensuring the effectiveness.

Citation： ZHENG Shuxin, SONG Yueming, WANG Lei. Current status of surgical treatment for angular kyphosis in spinal tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(4): 487-492. doi: 10.7507/1002-1892.202311059 Copy

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2. 华文彬, 杨操, 吴星火, 等. 陈旧性脊柱结核重度后凸畸形截骨矫正术. 中国矫形外科杂志, 2021, 29(13): 1222-1225.
3. Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. Int Orthop, 2012, 36(2): 359-365.
4. Rajasekaran S. Kyphotic deformity in spinal tuberculosis and its management. Int Orthop, 2012, 36(2): 359-365.
5. Xie JM, Chen ZQ, Shen JX, et al. Expert consensus for PVCR in severe, rigid and angular spinal deformity treatment: The Kunming consensus. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017713939.
6. Xie JM, Chen ZQ, Shen JX, et al. Expert consensus for PVCR in severe, rigid and angular spinal deformity treatment: The Kunming consensus. J Orthop Surg (Hong Kong), 2017, 25(2): 2309499017713939.
7. Ma S, Zhou Z, Yu H, et al. Global spinal realignment after osteotomized debridement in active lumbar spinal tuberculosis: correlation with patient-reported outcomes. World Neurosurg, 2022, 164: e1153-e1160.
8. Ma S, Zhou Z, Yu H, et al. Global spinal realignment after osteotomized debridement in active lumbar spinal tuberculosis: correlation with patient-reported outcomes. World Neurosurg, 2022, 164: e1153-e1160.
9. Yi Z, Song Q, Zhou J, et al. The efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis. Sci Rep, 2021, 11(1): 3591. doi: 10.1038/s41598-021-83178-0.
10. Yi Z, Song Q, Zhou J, et al. The efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis. Sci Rep, 2021, 11(1): 3591. doi: 10.1038/s41598-021-83178-0.
11. Xu Z, Zhang Z, Wu Y, et al. Posterior transforaminal debridement and interbody fusion with instrumentation for multi-segment thoracic spinal tuberculosis: a midterm follow-up study. Sci Rep, 2022, 12(1): 18244. doi: 10.1038/s41598-022-23169-x.
12. Xu Z, Zhang Z, Wu Y, et al. Posterior transforaminal debridement and interbody fusion with instrumentation for multi-segment thoracic spinal tuberculosis: a midterm follow-up study. Sci Rep, 2022, 12(1): 18244. doi: 10.1038/s41598-022-23169-x.
13. 张宏其, 唐明星, 肖力戈, 等. 经畸形复合椎截骨治疗脊柱结核角状后凸畸形的临床疗效. 中华骨科杂志, 2021, 41(12): 744-754.
14. 张宏其, 唐明星, 肖力戈, 等. 经畸形复合椎截骨治疗脊柱结核角状后凸畸形的临床疗效. 中华骨科杂志, 2021, 41(12): 744-754.
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17. Qiu J, Peng Y, Qiu X, et al. Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case-control study. BMC Surg, 2022, 22(1): 161. doi: 10.1186/s12893-022-01611-1.
18. Qiu J, Peng Y, Qiu X, et al. Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case-control study. BMC Surg, 2022, 22(1): 161. doi: 10.1186/s12893-022-01611-1.
19. Zhao C, Luo L, Liu L, et al. Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach. J Orthop Surg Res, 2020, 15(1): 343. doi: 10.1186/s13018-020-01876-3.
20. Zhao C, Luo L, Liu L, et al. Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach. J Orthop Surg Res, 2020, 15(1): 343. doi: 10.1186/s13018-020-01876-3.
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26. Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop, 2012, 36(2): 353-357.
27. Chunguang Z, Limin L, Rigao C, et al. Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis. J Pediatr Orthop, 2010, 30(3): 271-276.
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30. Zhong Y, Yang K, Ye Y, et al. Single posterior approach versus combined anterior and posterior approach in the treatment of spinal tuberculosis: a meta-analysis. World Neurosurg, 2021, 147: 115-124.
31. Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg (Br), 2008, 90(11): 1477-1481.
32. Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg (Br), 2008, 90(11): 1477-1481.
33. Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
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Chinese Journal of Reparative and Reconstructive Surgery

Current status of surgical treatment for angular kyphosis in spinal tuberculosis

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