Skip to main content

Advertisement

SpringerLink
Log in

Three-column osteotomy by single-stage posterior approach in congenital and post-tubercular kyphosis: a comparison of outcomes

  • Case Series
  • Published:
Spine Deformity Aims and scope Submit manuscript

Abstract

Purpose

To compare the clinical, radiological and functional outcomes of three-column osteotomy (3CO) by a single-stage posterior approach in patients with isolated congenital angular kyphosis (CK) and healed post-tubercular kyphosis (PTK).

Methods

The hospital records of 30 patients with isolated congenital kyphosis (Group CK) and 51 patients with healed post-tubercular kyphosis (Group PTK), operated at a single centre utilizing a 3CO by a single-stage posterior-only approach, were retrospectively analysed. The two groups were compared with respect to selected demographic variables with clinical, radiological and functional outcome measures at a minimum follow-up of 24 months.

Results

Patients in Group CK (median: 13 years, range: 4–30 years) presented earlier than those in Group PTK (median: 16 years, range: 6–45 years). The apex of the deformity was most often located in the thoracic spine in Group PTK, and in the thoracolumbar or lumbar spine in Group CK. The mean operative time (198.2 ± 31.5 min v/s 174.4 ± 34.5; p = 0.01) and estimated blood loss (859.6 ± 312.2 ml v/s 720.8 ± 187.3; p = 0.04) were significantly higher in Group PTK. While the local kyphosis angle was significantly corrected with surgery in both groups, the correction was significantly better in Group CK—this group also had significantly better overall functional (SRS-22r) scores at a follow-up of 24 months (p < 0.05). The overall complication rate (29.4% v/s 23.3%) and neurological complication rate (9.8% v/s 6.6%) were higher in Group PTK. Permanent neurological deterioration occurred in one patient in each group.

Conclusion

Patients with PTK have significantly higher age of presentation, higher operative time and higher complication rate as compared to CK. However, good functional outcomes and kyphosis angle correction can be achieved in both the groups with posterior-only three-column osteotomies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Code availability

Not applicable.

References

  1. Noordeen MH, Garrido E, Tucker SK et al (2009) The surgical treatment of congenital kyphosis. Spine 34(17):1808–1814. https://doi.org/10.1097/BRS.0b013e3181ab6307

    Article  CAS  PubMed  Google Scholar 

  2. Papadopoulos EC, Boachie-Adjei O, Hess O et al (2015) Early outcomes and complications of posterior vertebral column resection. Spine J 15(5):983–991. https://doi.org/10.1016/j.spinee.2013.03.023

    Article  PubMed  Google Scholar 

  3. Rajasekaran S (2012) Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 36:359–365. https://doi.org/10.1007/s00264-011-1469-2

    Article  PubMed  PubMed Central  Google Scholar 

  4. Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19(5):327–331. https://doi.org/10.1007/BF00181121

    Article  CAS  PubMed  Google Scholar 

  5. Schwab F, Blondel B, Chay E et al (2015) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 76(suppl_1):S33–S41. https://doi.org/10.1227/01.neu.0000462076.73701.09

    Article  PubMed  Google Scholar 

  6. Rajasekaran S, Rajoli SR, Aiyer SN et al (2018) A classification for kyphosis based on column deficiency, curve magnitude, and osteotomy requirement. J Bone Jt Surg Am 100(13):1147. https://doi.org/10.2106/JBJS.17.01127

    Article  CAS  Google Scholar 

  7. Hsu LC, Cheng CL, Leong JC (1988) Pott’s paraplegia of late onset. The cause of compression and results after anterior decompression. J Bone Jt Surg Br 70(4):534–538. https://doi.org/10.1302/0301-620X.70B4.3403593

    Article  CAS  Google Scholar 

  8. Bilsel N, Aydıngöz Ö, Hancı M et al (2000) Late onset Pott’s paraplegia. Spinal Cord 38(11):669–674. https://doi.org/10.1038/sj.sc.3101082

    Article  CAS  PubMed  Google Scholar 

  9. Suk SI, Kim JH, Kim WJ et al (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27(21):2374–2382. https://doi.org/10.1097/00007632-200211010-00012

    Article  PubMed  Google Scholar 

  10. Lenke LG, O’Leary PT, Bridwell KH et al (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34(20):2213–2221. https://doi.org/10.1097/BRS.0b013e3181b53cba

    Article  PubMed  Google Scholar 

  11. Hamzaoglu A, Alanay A, Ozturk C et al (2011) Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine 36(5):E340–E344. https://doi.org/10.1097/BRS.0b013e3182015712

    Article  PubMed  Google Scholar 

  12. Garg B, Mehta N (2020) Modified posterior vertebral column resection for severe spinal deformity: a retrospective, comparative study. Spine J 20(9):1446–1451. https://doi.org/10.1016/j.spinee.2020.04.014

    Article  PubMed  Google Scholar 

  13. Wang S, Aikenmu K, Zhang J et al (2017) The aim of this retrospective study is to evaluate the efficacy and safety of posterior-only vertebral column resection (PVCR) for the treatment of angular and isolated congenital kyphosis. Eur Spine J 26(7):1817–1825. https://doi.org/10.1007/s00586-015-4344-9

    Article  PubMed  Google Scholar 

  14. Garg B, Bansal T, Mehta N et al (2021) Clinical, radiological and functional outcome of posterior-only three-column osteotomy in healed, post-tubercular kyphotic deformity: a minimum of 2-year follow-up. Spine Deform. https://doi.org/10.1007/s43390-021-00361-z

    Article  PubMed  Google Scholar 

  15. McMaster MJ, Singh H (1999) Natural history of congenital kyphosis and kyphoscoliosis. A study of one hundred and twelve patients. JBJS 81(10):1367–1383

    Article  CAS  Google Scholar 

  16. Winter RB, Moe JH, Wang JF (1973) Congenital kyphosis: its natural history and treatment as observed in a study of one hundred and thirty patients. JBJS 55(2):223–274

    Article  CAS  Google Scholar 

  17. Marks DS, Qaimkhani SA (2009) The natural history of congenital scoliosis and kyphosis. Spine 34(17):1751–1755. https://doi.org/10.1097/BRS.0b013e3181af1caf

    Article  PubMed  Google Scholar 

  18. Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children: radiological signs which predict late increase in deformity. J Bone Jt Surg Br 83(7):954–962. https://doi.org/10.1302/0301-620X.83B7.0830954

    Article  CAS  Google Scholar 

  19. Shi B, Zhao Q, Xu L et al (2018) SRS-Schwab Grade 4 osteotomy for congenital thoracolumbar kyphosis: a minimum of 2 years follow-up study. Spine J 18(11):2059–2064. https://doi.org/10.1016/j.spinee.2018.04.011

    Article  PubMed  Google Scholar 

  20. Zeng Y, Chen Z, Qi Q et al (2012) Clinical and radiographic evaluation of posterior surgical correction for the treatment of moderate to severe post-tuberculosis kyphosis in 36 cases with a minimum 2-year follow-up. J Neurosurg Spine 16(4):351–358. https://doi.org/10.3171/2011.12.SPINE11568

    Article  PubMed  Google Scholar 

  21. Nadler SB, Hidalgo JU, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(2):224–232. https://doi.org/10.5555/uri:pii:0039606062901666

    Article  PubMed  Google Scholar 

  22. Rampersaud YR, Moro ER, Neary MA et al (2006) Intraoperative adverse events and related postoperative complications in spine surgery: implications for enhancing patient safety founded on evidence-based protocols. Spine 31(13):1503–1510. https://doi.org/10.1097/01.brs.0000220652.39970.c2

    Article  PubMed  Google Scholar 

  23. Rajasekaran S, Vijay K, Shetty AP (2010) Single-stage closing–opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J 19(4):583–592. https://doi.org/10.1007/s00586-009-1234-z

    Article  CAS  PubMed  Google Scholar 

  24. Srivastava SK, Aggarwal RA, Bhosale SK et al (2019) Apical vertebral column resection with sagittal rotation and controlled anterior opening and posterior closing maneuver for the treatment of severe post-tubercular kyphosis: case series and literature review. Asian Spine J 13(3):478. https://doi.org/10.31616/asj.2018.0222

    Article  PubMed  PubMed Central  Google Scholar 

  25. World Health Organization (2020) Global tuberculosis report 2020: executive summary

Download references

Funding

No external funding was used for the study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Bhavuk Garg, Tungish Bansal & Nishank Mehta

  2. Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India

    Tungish Bansal

Authors
  1. Bhavuk Garg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tungish Bansal
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nishank Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Concept and design: BG; intellectual content: BG, TB, NM; literature search: TB; data acquisition: TB, NM; data analysis: BG, TB, NM; manuscript preparation: TB, NM; manuscript editing: BG, TB, NM; approval of final version of manuscript: BG, TB, NM; accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work: BG, TB, NM.

Corresponding author

Correspondence to Tungish Bansal.

Ethics declarations

Conflict of interest

Dr. Bhavuk Garg, Dr. Tungish Bansal, and Dr. Nishank Mehta declare that they have no conflict of interest.

Ethical approval

Approval was obtained from the Ethics Committee of All India Institute of Medical Sciences, New Delhi. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent to publish

Patients signed informed consent regarding publishing their data and photographs.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Garg, B., Bansal, T. & Mehta, N. Three-column osteotomy by single-stage posterior approach in congenital and post-tubercular kyphosis: a comparison of outcomes. Spine Deform 10, 883–892 (2022). https://doi.org/10.1007/s43390-022-00491-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s43390-022-00491-y

Keywords

Search

Navigation