Toluse Adetunji, Adeyemi Taofeek, Samuel Solomon, Biala Adebola, Izuka Albert
Orthopedic and Trauma Surgery, National Orthopaedic Hospital, Lagos, NGA.
Cureus. 2023 Feb 6;15(2):e34685. doi: 10.7759/cureus.34685. eCollection 2023 Feb.
Tuberculosis of the vertebral column (Pott's disease) accounts for up to one-half of musculoskeletal tuberculous infections. The eradication of the infective organism () is achievable with chemotherapy. However, such patients with spinal tuberculosis are at risk of developing spinal deformity, and 3%-5% of the patients develop severe deformity greater than 60°. A 30-year-old female presented with back pain of 11 years, discharging sinus, and progressively worsening kyphotic deformity of eight-year duration. She had completed a full course of anti-tubercular chemotherapy. Her neurological examination was within normal limits. Antero-posterior and lateral view radiographs showed osteolytic destruction and collapsed T12 and L1 vertebrae with a thoracic kyphosis of 90°. We did a single-stage posterior-approach closing-opening osteotomy surgery utilizing costotransversectomy (T12 and L1 corpectomy, the insertion of expandable titanium cage, T10 to L3 pedicle screw, and rod fusion). Postoperative kyphosis was 25°. Her motor and sensory functions remained preserved following surgery. The duration of follow-up was 18 months post operation. The mainstay of treatment of severe post-tubercular kyphosis (PTK) is surgery. The correction is complex and could be staged or with multiple approaches and consequent high risk of complications. A single-stage posterior-approach surgery is less invasive.
脊柱结核（波特氏病）占肌肉骨骼结核感染的一半。通过化疗可实现感染病原体的根除。然而，此类脊柱结核患者有发生脊柱畸形的风险，3%至5%的患者会出现大于60°的严重畸形。一名30岁女性，背痛11年，有窦道流脓，且有持续8年逐渐加重的后凸畸形。她已完成全程抗结核化疗。其神经系统检查正常。前后位和侧位X线片显示T12和L1椎体骨质溶解破坏并塌陷，胸椎后凸90°。我们采用经肋横突切除术进行了单阶段后路闭合-开放截骨手术（T12和L1椎体次全切除，植入可扩张钛笼，T10至L3椎弓根螺钉及棒融合）。术后后凸为25°。术后其运动和感觉功能得以保留。术后随访时间为18个月。严重结核后凸畸形（PTK）的主要治疗方法是手术。矫正过程复杂，可能需要分期或采用多种入路，因此并发症风险高。单阶段后路手术创伤较小。
