En bloc spondylectomy for the treatment of spinal tuberculosis with fixed and sharply angulated kyphotic deformity.

Abstract

Thirty-four patients having advanced spinal tuberculosis with angulated kyphotic deformity who underwent posterior en bloc spondylectomy were reviewed. To evaluate clinical outcomes of posterior en bloc spondylectomy in patients having spinal tuberculosis with angulated kyphotic deformity. Spinal tuberculosis may be associated with angulated kyphotic deformity. The conventional treatment for angular kyphosis is combined anterior and posterior decompression, fusion, and stabilization. From 1998 to 2005, 34 patients (mean age, 25.1 years) underwent posterior 1-stage en bloc spondylectomy. The level of tuberculosis and kyphosis was T9 in 2 patients, T10 in 5, T11 in 13, T12 in 14, and L1 in 12. The anterior column with tuberculosis present was completely removed by en bloc spondylectomy. Strut autograft was used to restore anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. RESULTS.: No perioperative mortality occurred in these patients. At follow-up, according to Odom's classification, the excellent outcome was seen in 9 patients, good in 23, fair in 1, and poor in 1. The kyphotic Cobb angle improved from the preoperative average of 57.8 degrees to a postoperative average of 11.4 degrees. The average horizontal distance between C7 and S1 was 13.9 mm before surgery and 3.9 mm after surgery. Seventeen patients showed a postoperative improvement in American Spinal Injury Association grade after the operation. The perioperation complication occurred in 3 of the 34 cases. Two patients had evidence of screw loosening at follow-up. Ten patients had questionable fusion or pseudarthrosis. The purpose of this article is more to describe the technique of posterior en bloc spondylectomy in patients with spine tuberculosis with kyphotic deformity. From the results of this preliminary study, en bloc spondylectomy for the treatment of spinal tuberculosis with angulated kyphotic deformity can be a safe and effective technique.