Posterior vertebral column resection and intraoperative manual traction to correct severe post-tubercular rigid spinal deformities incurred during childhood: minimum 2-year follow-up.

PURPOSE: To evaluate the clinical and radiographic outcomes of posterior vertebral column resection (PVCR) and intraoperative manual traction to correct severe post-tubercular spinal deformity incurred during childhood.

METHODS

A retrospective review of 11 patients' (4 males and 7 females) charts was performed. Clinical outcome assessment was performed using Oswestry Disability Index and Visual Analog Scale for back pain. Imaging measurements and fusion status were assessed using plain radiography and computed tomography. Intraoperative and postoperative complications were recorded.

RESULTS

No perioperative mortality occurred among the patients. The average follow-up was 42.8 ± 13.1 months (range 25-60 months). Kyphosis improved from a preoperative average of 93.4° ± 10.1° to a postoperative average of 18.7° ± 6.3° for a correction of 80.1 %. The Cobb angle in the coronal plane improved from an average of 48.1° ± 18.9° to 10.3° ± 3.0° postoperatively for a correction of 76.3 %. At the last follow-up, two patients improved neurologically from ASIA grade C to grade D, and one patient improved from grade C to grade E. Only one patient with ASIA grade D deficits did not improve. Perioperative complications occurred in 4 of the 11 cases. One patient had a dural tear. Three patients had temporary degradation of intraoperative neuromonitoring, and one experienced transient paralysis of the left lower extremity postoperatively.

CONCLUSIONS

PVCR and intraoperative manual traction are effective alternatives to manage severe post-tubercular spinal deformity although the procedure can be highly challenging with possible neurologic complications.