Kyphus Correction in Spinal Tuberculosis

Abstract

Late-onset paraplegia is best avoided by correcting severe kyphosis in the active, healing, or healed stages of spinal tuberculosis. We report 16 patients with dorsal or dorsolumbar spinal TB-nine with paraplegia, seven without paraplegia-who underwent kyphus correction. Nine patients had active, five partially treated, and two healed disease. The patients ranged in age from 3 to 38 years and had a mean kyphosis of 58.5° (range, 35°-76°). Mean vertebral body involvement on computed tomography was 4.2 (2-9), and mean initial vertebral body loss was 1.76 (1-2.6). The sequential steps for kyphus correction were anterior corpectomy, shortening of the posterior column, posterior instrumentation and anterior gap grafting, and posterior fusion as a single-stage procedure by the extrapleural anterolateral (costotransversectomy) approach. Minimum followup was 3 months (range, 3-36 months). All but one patient with neural deficit showed complete neural recovery. Mean kyphosis correction was 27.3° (range, 9°-42°). Mean correction loss on 1-year followup was 1.4° (range, 0°-4°). Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.