Modified posterior vertebral column resection for extremely severe post-tubercular kyphosis in adults: a two-year follow-up.

IF 2.8 3区医学 Q1 ORTHOPEDICS Journal of Orthopaedic Surgery and Research Pub Date : 2025-02-18 DOI:10.1186/s13018-025-05595-5

Jingyu Wang, Xiaohui Wang, Xueying Zhang, Hua Hui, Dingjun Hao

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Abstract

Objective: To describe the clinical and radiographic outcomes of patients with severe post-tubercular kyphosis (PTK) in adults who underwent modified posterior vertebral column resection (mPVCR).

Methods: A retrospective analysis was conducted on data from 22 patients with severe PTK who underwent surgical treatment. All patients received a one-stage mPVCR deformity correction. General information, radiological parameters including kyphosis angle (KA) and sagittal vertical axis (SVA), functional outcomes including America Spinal Injury Association (ASIA) grades, Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) scores, and complications were recorded.

Results: The mean age of the population was 33.6 ± 11.6 years (range: 18-59 years). The average operation time was 383.2 ± 53.8 min, and the mean intraoperative blood loss was 1652.3 ± 331.8 ml. Significant changes in KA (preoperative: 129.5 ± 17.3° vs. postoperative: 43.7 ± 7.6°; p < 0.001) and SVA (preoperative: 30.9 ± 7.5 mm vs. postoperative: 15.0 ± 4.1 mm; p < 0.001) were observed after the surgery. In addition, the mean SRS-22 scores improved following surgical correction, with the most significant improvement in the self-image domain. The overall complication rate was 36.4%, including 6 non-neurological and 2 neurological complications. Although two patients experienced transient neurological deterioration postoperatively, a significant improvement in patients' ASIA grades and ODI scores was found at final follow-up compared to preoperative values.

Conclusion: Modified PVCR represents a safe surgical option for patients with extremely severe PTK requiring aggressive correction. Delayed resection of the posterior elements may contribute to reducing intraoperative blood loss and iatrogenic spinal cord injury during osteotomy. Appropriate correction, while avoiding overcorrection, is beneficial for decreasing neurologic complications.

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改良后脊柱切除术治疗成人极严重结核后后凸：两年随访。

目的：描述接受改良后脊柱切除术（mPVCR）的成人严重结核性后凸（PTK）患者的临床和影像学结果。方法：对22例手术治疗的重症PTK患者资料进行回顾性分析。所有患者均接受一期mPVCR畸形矫正。记录一般信息、放射学参数（包括后凸角（KA）和矢状垂直轴（SVA））、功能结局（包括美国脊柱损伤协会（ASIA）分级、Oswestry残疾指数（ODI）、脊柱侧凸研究协会-22 （SRS-22）评分）和并发症。结果：人群平均年龄33.6±11.6岁，年龄范围18 ~ 59岁。平均手术时间383.2±53.8 min，平均术中出血量1652.3±331.8 ml。KA变化显著(术前：129.5±17.3°vs术后：43.7±7.6°；结论：改良PVCR对于需要积极矫正的极严重PTK患者是一种安全的手术选择。延迟切除后椎体可能有助于减少术中出血量和医源性脊髓损伤。适当矫治，避免矫治过度，有利于减少神经系统并发症。

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来源期刊

Journal of Orthopaedic Surgery and Research ORTHOPEDICS-

CiteScore

4.10

自引率

7.70%

发文量

494

审稿时长

>12 weeks

期刊介绍： Journal of Orthopaedic Surgery and Research is an open access journal that encompasses all aspects of clinical and basic research studies related to musculoskeletal issues. Orthopaedic research is conducted at clinical and basic science levels. With the advancement of new technologies and the increasing expectation and demand from doctors and patients, we are witnessing an enormous growth in clinical orthopaedic research, particularly in the fields of traumatology, spinal surgery, joint replacement, sports medicine, musculoskeletal tumour management, hand microsurgery, foot and ankle surgery, paediatric orthopaedic, and orthopaedic rehabilitation. The involvement of basic science ranges from molecular, cellular, structural and functional perspectives to tissue engineering, gait analysis, automation and robotic surgery. Implant and biomaterial designs are new disciplines that complement clinical applications. JOSR encourages the publication of multidisciplinary research with collaboration amongst clinicians and scientists from different disciplines, which will be the trend in the coming decades.