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Spinal Osteotomy: Correcting Sagittal Balance in Tuberculous Spondylitis

Gokce, Alper MD*; Ozturkmen, Yusuf MD; Mutlu, Savas MD; Caniklioğlu, Mustafa MD

Journal of Spinal Disorders & Techniques: October 2008 - Volume 21 - Issue 7 - p 484-488
doi: 10.1097/BSD.0b013e3181586023
Original Articles
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Study Design Retrospective case analysis.

Objective Tuberculosis spondylitis is a cause of sagittal imbalance and neurologic impairment. In this study, the result of decompression and closing wedge osteotomy with instrumented fusion performed in patients with tuberculous spondylitis were analyzed retrospectively.

Summary of Background Data Twelve patients with angular kyphotic deformity underwent decompression and closing wedge osteotomy with instrumented fusion between 2000 and 2004. Clinical and radiologic assessment was based on pain, functional and neurologic status, and radiologic measurements.

Methods There were 7 men and 5 women with median age of 52 years (range, 24 to 76 y). The average follow-up period was 62 months (range, 48 to 70 mo). The radiologic involvement included the angle of kyphosis on the anteroposterior and lateral radiographs. The preoperative and postoperative clinical assessments were performed by the using Oswestry Disability Index. All patients were asked to rate their preoperative and postoperative pain measurement using a pain visual analog scale.

Results Visual analog scale scores improved from 5.8 in average (range, 4 to 8) to 2.2 in average (range, 1 to 4) and in the mean and Oswestry Disability Index from 54.2 (46 to 60) preoperatively to 15.2 (8 to 22) at the latest follow-up. Four patients presented neurologic findings. Three patients had improvement in their neurologic status, 1 patient did not improve and remained as American Spinal Injury Association (ASIA) grade C. Kyphotic deformity of the patients has improved from 51.1 to 23.2 degrees postoperatively. One of them has to be revised and instrumentation was extended to upper levels. Fusion was achieved at the last follow-up.

Conclusions Despite developing pseudarthrosis secondary to implant failure in 1 case, we recommend debridement, closing wedge osteotomy, and posterior instrumented fusion to correct sagittal balance in tuberculous spondylitis.

*Department of Orthopaedics and Traumatology, Yeditepe University

2nd Clinic of Orthopaedics and Traumatology, Turkish Health Ministerium Istanbul Training Hospital, Istanbul, Turkey

Reprints: Alper Gokce, MD, Department of Orthopaedics and Traumatology, Yeditepe University, Devlet yolu Ankara cd. No: 102-104 Kozyatagi, 34752 Kadikoy, Istanbul, Turkey (e-mail: a.gokce@yahoo.com).

Received for publication May 16, 2007; accepted August 11, 2007

© 2008 Lippincott Williams & Wilkins, Inc.