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International Surgery and Ortho Conference
October 25-26, 2017 | Toronto, Canada
Case Rep Surg Invasive Proced 2017 | Volume 1 Issue 3
Surgical correction of severe kyphotic deformity in spinal tuberculosis
Justin Arockiaraj
Christian Medical College and Hospital, India
Aim:
The aim of this study is to evaluate the clinical and
radiological outcome of surgical management of 24 patients
with severe Tubercular kyphosis (>60 degrees).
Materials & Methods:
From 2000 - 2015, 24 patients were
surgically treated for tuberculous kyphosis. The average age
was 23 years (range 8 – 46 years). The mean kyphosis angle was
70° (60° - 97.7°). Mean vertebral loss was 2.6. Nine patients had
significant neurological deficit (Frankel A, B, C). Eleven patients
had active disease. A single approach was used in 19 patients
and the remaining had staged surgery. Pedicle screws were
used in 18 patients and Hartshill rectangle in 6 patients. The
anterior column was reconstructed with autologous bone in 9
patients and titanium cage in 15 patients. The average follows
up of the patients was 3 years (1-12years). Clinical outcome was
based on Macnab’s criteria.
Results:
The average correction of kyphosis was 32°. The loss
of correction at final follow up was 8°. All patients had healing
of disease. Significant neural recovery was seen in 10 (83%)
patients 3 patients had neurological deterioration, of which
2 improved and one patient did not have any recovery in
neurology. Graft slippage, graft fracture and implant failure and
superficial wound infection was seen in one patient each. The
implant was removed in 2 patients. There was no mortality.
Discussion:
Inspite of adequate chemotherapy patients with
tubercular kyphosis may demonstrate worsening deformity
resulting in late onset paraplegia and grotesque deformities.
This is best avoided by correcting severe deformity in active,
healing or healed stages of spinal tuberculosis.
Conclusion:
Surgical correction of severe tubercular kyphotic
deformities involves anterior debridement/release and
reconstruction with posterior column shortening and posterior
instrumentation with fusion. Though hazardous and technically
demanding it yields clinically and radiologically gratifying results.
Speaker Biography
Justin Arockiaraj have completed his undergraduate (MBBS) and post graduate
training (D. Ortho., M.S. Ortho., DNB Orthopaedics) in the field of Orthopaedics, at the
Christian Medical College and Hospital, Vellore, India. He is currently working as an
Associate Professor in the Spinal Disorder Surgery unit, Department of Orthopaedics.
He is interested in academics and teaching. He is also a resource person for Distance
Education Program and Post graduate Diploma in Family Medicine. He regularly
take classes for under graduate students, post graduate students and spine fellows.
Tuberculosis is one among his favorite topics. He has couple of publications both in
national and international journals.
e:
svjustin.arockiaraj@gmail.com