Severe Pott's Kyphosis in a 19-Month-Old Child: Case Report and Review of Literature

A novel surgical strategy of three column osteotomy at non-lesioned area for correcting severe angular kyphosis due to Pott's disease: a retrospectively study

Severe sharp angular kyphosis resulting from Pott's disease typically necessitates surgical intervention. The deployment of three-column osteotomy within the lesion and apical regions has been validated as an effective modality for the amelioration of angular kyphosis. Nonetheless, a propensity for residual kyphosis persists, accompanied by a significant perioperative risk profile. In pursuit of optimizing correctional outcomes and diminishing complication rates, we proposed an innovative surgical approach, utilizing osteotomy in the non-lesioned zones for the rectification of severe angular kyphosis associated with Pott's disease. This retrospective investigation encompasses 16 subjects who underwent this novel surgical tactic, involving osteotomies in non-lesioned vertebral segments, at our institution from 2016 to 2018. Radiographic measures, encompassing kyphotic angle and sagittal vertical axis (SVA), were documented at baseline and during terminal follow-up. Neurological status was evaluated via the American Spinal Injury Association (ASIA) grading system. Operative duration, volume of hemorrhage, and perioperative complications were systematically recorded. The cohort included 6 males and 10 females with an average age of 30.7 ± 11.41 years. Follow-up intervals spanned 24 to 42 months. Mean operative time and blood loss were 492 ± 127.3 min and 1791 ± 788.8 ml, respectively. The kyphotic angle improved from 97.6 ± 14.6° to 28.8 ± 18.70°. In cases with lumbar afflictions, vertebral restoration was achieved (L1-L5 and L2-S1). Initial mean SVA of 6.7 ± 3.58 cm was reduced to 3.3 ± 1.57 cm at follow-up. Neurological function enhancement was observed in six patients, while ten maintained baseline status. Complication rates, including wound infection and rod fracture at 12 months, were observed in approximately 11.8% of cases. Our findings suggest that the surgical strategy is both effective and safe for addressing severe angular kyphosis due to Pott's disease, contingent upon the expertise of the surgical unit.

One-Stage Posterior Vertebral Column Resection in the Treatment of Adolescent Thoracic and Lumbar Tuberculosis Complicated With Severe Kyphotic Deformity

BACKGROUND

Our study aims to investigate the clinical outcome of 1-stage posterior vertebral column resection (PVCR) for adolescent thoracic and lumbar tuberculosis with severe kyphotic deformity (Cobb angle≥60°).

METHODS

Between January 2008 and January 2016, we recorded 16 (9 male, 7 female) adolescent cases of thoracic and lumbar tuberculosis complicated with severe kyphotic deformity treated by 1-stage PVCR (average age: 15.38 ± 1.54 years; range: 13-18 years). The Cobb angle of kyphosis was 64.56° ± 3.41°. According to the American Spinal Injury Association (ASIA) classification, all patients were classified preoperatively. The lesions involved T4-T11 in 10 cases and T12-L2 in 6 cases.

RESULTS

The mean follow-up time was 19.06 ± 11.42 months (range: 12-48 months). Based on ASIA classification, postoperative grades were significantly increased compared with preoperative grades (P < 0.05), The mean Cobb angle was significantly corrected to 20.25° ± 13.83° at 1 week after surgery, when compared with preoperative Cobb angle (P < 0.05). There was no significant difference in Cobb angle between 1-week after operation and the last follow-up (20.69° ± 13.83°) (P > 0.05). All the patients achieved bony fusion at a mean time of 14 months (range: 10-20 months) postoperatively. No fixation loosening, displacement, or fracture was observed during follow-up.

CONCLUSIONS

One-stage PVCR is an effective surgical method for the treatment of adolescent thoracic and lumbar spinal tuberculosis with severe kyphotic deformity, which can completely remove the lesion, effectively correct the kyphosis deformity, and prevent related complications.