Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature.

Abstract

PURPOSE:

The purpose of this study was to evaluate the clinical and radiographic outcomes of modified pedicle subtraction osteotomy (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients.

METHODS:

From January 2008 to August 2012, 26 consecutive pediatric patients with thoracolumbar post-tubercular kyphosis underwent modified pedicle subtraction osteotomy (mPSO). The clinical and radiologic outcomes were analyzed preoperatively, postoperatively, and at the last follow-up.

RESULTS:

Twenty-six patients with thoracolumbar post-tubercular kyphosis underwent mPSO. The average operation time was 256 min (188~314 min). The mean follow-up was 41 months (18~56 months). The mean estimated blood loss was 870 ml (620 ~ 1020 ml). The thoracolumbar kyphotic angle ranged from 51° to 79° before operation, 60.6° in average. The mean thoracolumbar kyphotic Cobb angle was 19.7° after operation, with a mean correction of 40.9°. The C7 sagittal plumb line was 3.8 cm after operation, comparing to the 10.5 cm preoperative. The mean preoperative angle of thoracic kyphosis (TK) was 9.9° ± 1.2° and increased to 11.8° ± 1.4°, postoperatively. Lumbar lordosis (LL) improved from -22.8° ± 4.9° preoperative to -17.8° ± 2.1° postoperative. Visual analogue scale (VAS) was 8.7 ± 1.1 preoperative and 1.2 ± 0.4 postoperative, respectively. The mean Oswestry Disability Index (ODI) improved from 49.2 ± 5.3 before surgery to 10.8 ± 3.3 postoperative (P < 0.01). All patients received good bone healing, no significant loss of correction angle. Most patients (24/26) considered pain and exterior was significantly improved.

CONCLUSION:

Modified pedicle subtraction osteotomy (mPSO) is effective and reliable for thoracolumbar post-tubercular kyphosis in pediatric patients.

• Authors: Zhang Hong-Qi, Chen Yong, Huang Jia, Guo Chaofeng, Hu Xiongke
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 31 Issue 8 Pg. 1347-54 (Aug 2015) ISSN: 1433-0350 [Electronic] Germany
• PMID: 25953095 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Coagulants
• Vitamin K

Topics

• Adolescent
• Child
• Coagulants (therapeutic use)
• Female
• Humans
• Male
• Osteotomy (methods)
• Pain Measurement
• Postoperative Care (methods)
• Retrospective Studies
• Scheuermann Disease (etiology, surgery)
• Thoracic Vertebrae (surgery)
• Tomography, X-Ray Computed
• Treatment Outcome
• Tuberculosis, Spinal (complications)
• Vitamin K (therapeutic use)