Abstract
Introduction
Acute tuberculous spondylodiscitis with thoracic kyphosis is conventionally treated by anterior or combined reconstruction techniques. Posterior based sagittal correction in active tubercular infection is an emerging alternative technique. Our aim was to evaluate posterior only deformity correction technique in acute tuberculosis kyphosis for safety and outcomes.
Methods
Sixty-seven patients with acute thoracic kyphosis due to tuberculosis were treated by all-posterior deformity correction with or without an anterior cage. Peri-operative complications, neurological improvement, pain scores, kyphosis correction, final deformity at last follow up and fusion were studied pre-operatively, immediately after surgery and at last follow up.
Results
The mean age was 47.6 ±12.2 years. Indications for surgery were persistent pain (n = 12), neurological deficit (n = 27) and kyphosis (n = 28). The mean follow-up was 36.4 ± 12.1 months. The mean VAS improved from 7.2 ±1.2 to 1.6 ±0.9. The mean kyphotic angle improved from 26.4 ±4.6° to 12.4 ±2.4°. There was loss of correction by 2.7° and the final kyphosis was 15.2 ± 1.8°. Neurology improved in all patients by at least one ASIA grade. The mean vertebral body loss was 0.8 ± 0.4 (where 1=one vertebral body). Thirty seven patients with vertebral loss > 0.5 or pre-operative kyphosis > 30 degress had transpedicular/transformaninal reconstruction of anterior column with a cage while the remaining thirty had posterior shortening only. Bony fusion was obtained in all patients. There were no implant failures. Post-operative complications included dural tear (n = 2), temporary neural deficit (n = 2), wound infection (n = 4), girdle paresthesia (n = 3), lumbar hernia (n = 2), disease recurrence (n = 1).
Conclusion
All-posterior single stage kyphosis correction and global reconstruction in acute tuberculous kyphosis is a safe technique with good functional and radiological outcomes. The use of titanium cages and pedicle screws in the infected vertebral body milieu was observed to be safe.