Orthopedic Department, Peking University 3rd Hospital, Beijing, China.
J Neurosurg Spine. 2012 Apr;16(4):351-8. doi: 10.3171/2011.12.SPINE11568. Epub 2012 Jan 20.
The object of this study was to compare the clinical and radiographic outcomes of 36 patients with posttuberculosis kyphosis who underwent one of two types of osteotomy.
Each patient underwent single-stage correction via a posterior surgical approach. A modified pedicle subtraction osteotomy (mPSO) was performed when the kyphotic deformity was less than 70° (7 cases), whereas a posterior vertebral column resection (VCR) was performed when the kyphotic deformity exceeded 70° (29 cases). Full-length standing radiographs were obtained before surgery and at follow-up visits. These images were used to measure the kyphosis angle; sagittal alignment of the lumbar, thoracic, and cervical regions; and sagittal balance of the spine. Back pain was rated using the visual analog scale (VAS), and neurological function was classified based on the American Spinal Injury Association (ASIA) grading system. Each patient's overall satisfaction with surgical treatment was measured with the Patient Satisfaction Index. For purposes of comparison, patients were studied in 2 groups based on the region of their kyphotic apex. Half of the cohort had apical kyphosis in the lower thoracic spine or thoracolumbar junction (TL group). Using both radiographic and clinical assessments, the authors compared this group with the other half of the patients who had apical kyphosis in the upper to mid thoracic spine (MT group).
The cohort included 15 males and 21 females, with an average age of 34 years at the time of surgery. The minimum follow-up was 24 months, and the mean follow-up was 31 months. Following surgery, kyphosis across the treated segments was reduced by an average of 60°. Lumbar lordosis also improved by an average of 24°, and thoracic kyphosis improved by an average of 20°. Both back pain and neurological function improved after surgical treatment. There was a 67% improvement in VAS scores, and 13 of the 36 patients had improvement in their ASIA grade. The 2 surgical procedures used for deformity correction (mPSO and VCR) demonstrated comparable radiographic and clinical results. Note, however, that differences were found in both radiographic and clinical outcomes in comparing patients who had lower thoracic or thoracolumbar (TL group) versus upper to midthoracic (MT group) apical kyphosis.
Posterior tubercular kyphosis can be effectively improved through corrective surgery, and deformity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, both the mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities. Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities in different regions of the spine.
本研究旨在比较两种类型的截骨术治疗 36 例肺结核后后凸畸形患者的临床和影像学结果。
所有患者均通过后路一期矫正。当后凸畸形小于 70°时（7 例），行改良经椎弓根楔形截骨术（mPSO）；当后凸畸形大于 70°时（29 例），行后路脊柱全长截骨术（VCR）。术前及随访时均拍摄全长站立位 X 线片，测量后凸角、腰椎、胸椎、颈椎矢状位排列和脊柱矢状位平衡。腰痛采用视觉模拟评分法（VAS）评定，神经功能根据美国脊柱损伤协会（ASIA）分级系统进行分级。采用患者满意度指数（PSI）测量每位患者对手术治疗的整体满意度。为了便于比较，根据后凸顶点所在区域将患者分为两组：一半患者的后凸顶点位于下胸段或胸腰段（TL 组），另一半患者的后凸顶点位于中上胸段（MT 组）。作者通过影像学和临床评估比较了这两组患者。
队列包括 15 名男性和 21 名女性，手术时平均年龄为 34 岁。最短随访时间为 24 个月，平均随访时间为 31 个月。术后治疗节段的后凸畸形平均减少 60°，腰椎前凸平均增加 24°，胸椎后凸平均增加 20°。术后腰痛和神经功能均改善。VAS 评分平均改善 67%，36 例患者中有 13 例 ASIA 分级改善。两种矫正畸形的手术方法（mPSO 和 VCR）均显示出相似的影像学和临床结果。然而，在比较下胸段或胸腰段（TL 组）与中上胸段（MT 组）后凸顶点的患者时，发现了影像学和临床结果的差异。
肺结核后凸畸形可通过矫形手术有效改善，畸形矫正可伴有临床症状的改善。当选择合适时，mPSO 和 VCR 都可预期获得满意的结核后后凸畸形矫正效果。然而，在脊柱不同区域治疗此类畸形时，应预计会出现影像学和临床结果的差异。
