1Department of Neurosurgery, Daegu Catholic University Medical Center, College of Medicine, Catholic University of Daegu, Daegu.
2Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University; and.
J Neurosurg Spine. 2019 May 10;31(3):418-423. doi: 10.3171/2019.3.SPINE18937. Print 2019 Sep 1.
Late-onset neurological deficits are a rare complication of spinal tuberculosis that may be caused by proximal adjacent segment degeneration (ASD) above the kyphus. The objective of this study was to report several cases of neurological deficits due to proximal ASD in patients with post-tuberculous kyphotic deformity and discuss the characteristics of the authors' corrective surgical technique.
The inclusion criteria in this study were severe angular kyphosis due to a post-tuberculous kyphotic deformity and a late-onset neurological deficit. The cause of these deficits was related to a lesion in the proximal cephalad portion of the kyphotic deformity. Surgical intervention, including decompression and compromised restoration of the sagittal imbalance, was performed in all patients. Preoperative surgical planning with a radiological evaluation included CT, plain radiograph, and MRI studies. Clinical outcomes were evaluated using the American Spinal Injury Association Impairment Scale and the Oswestry Disability Index (ODI).
The main goal of our surgical technique was the correction of sagittal malalignment by positioning the patient's head above the kyphotic deformity on the sagittal plane, excluding aggressive osteotomy. The neurological symptoms showed immediate improvements postoperatively, except in 1 patient. Compared to the preoperative value of 66.9, the mean ODI score improved to 42.6 at the final follow-up for all patients. Preoperatively, the mean values of the angles of deformity and the sagittal vertical axis were 99.7° and 157.7 mm, respectively, and decreased to 75.3° and 46.0 mm, respectively, at the final follow-up. No major complications were observed, and the patients' self-satisfaction was high with respect to both cosmetic and functional outcomes.
Clinicians should be aware of the degeneration of the vertebrae above the kyphotic segment in patients with post-tuberculosis deformity. Successful neurological recovery and compromised sagittal balance could be obtained by using our "head on kyphus" surgical concept.
迟发性神经功能缺损是脊柱结核的罕见并发症，可能由脊柱后凸上方的邻近节段近端退行性变（ASD）引起。本研究的目的是报告几例因结核后脊柱后凸畸形伴迟发性神经功能缺损患者的 ASD 近端神经功能缺损病例，并讨论作者矫正手术技术的特点。
本研究的纳入标准为结核后脊柱后凸畸形导致严重角状后凸和迟发性神经功能缺损。这些缺陷的原因与后凸畸形的近端颅侧部分的病变有关。所有患者均行手术干预，包括减压和矢状失衡的妥协恢复。术前手术计划包括 CT、平片和 MRI 研究。使用美国脊髓损伤协会损伤量表和 Oswestry 残疾指数（ODI）评估临床结果。
我们手术技术的主要目标是通过将患者的头部置于矢状面上的脊柱后凸畸形上方来纠正矢状面失平衡，不进行激进的截骨术。除 1 例患者外，所有患者术后神经症状均立即改善。与术前的 66.9 相比，所有患者的 ODI 评分最终随访时平均改善至 42.6。术前，畸形角和矢状垂直轴的平均值分别为 99.7°和 157.7mm，最终随访时分别降至 75.3°和 46.0mm。未观察到重大并发症，患者对美容和功能结果均非常满意。
临床医生应意识到结核病后畸形患者脊柱后凸节段上方椎体的退变。通过使用我们的“头部在脊柱后凸上”手术理念，可以获得成功的神经恢复和妥协的矢状平衡。
