Closing-opening Wedge Osteotomy of Spine to Correct Severe Post-Tubercular Kyphotic Deformities of the Spine: A Three-Year Follow-Up of 13 Patients

Patients and Methods: Thirteen patients with kyphotic deformity due to healed spinal tuberculosis (eight males; five females) with an average age of 14.84±7.19 years (range 7-32 years) formed the patient group. There were eight thoraco-lumbar and five thoracic deformities. The number of vertebrae involved in the fusion mass ranged from two to five. Preoperative kyphosis averaged 64.2 ±27.6 (range 26 -104). The average vertebral body loss was 2.07±0.9 (range 1.1-4.1). The neurological status was normal in nine patients, Frankel's Grade D in three patients and Grade C in one patient. All patients were operated by posterior approach.

Result: Average operating time was 4½ hours (3.2-5.4 hours) with blood loss of 810 ml (range 500-1600 ml). The post-operative kyphosis averaged 33.5 ±24 (range 8 -71 ). The average deformity correction was 30.70±8.70 (range 18 -52 ) following surgery. The percentage correction of kyphosis achieved was 53.1±16.8% (range 26-77%). Anterior reconstruction was performed using rib grafts in four, tricortical iliac bone graft in five, cages in two, and bone chips alone and fibular graft in one patient each. No patients with normal preoperative neurological status showed deterioration in neurology after surgery. The last follow-up was at an average of 42±5 months (range 31-54 months). The average loss of correction at the last follow-up was 4.20 (range 30-60). Complications were superficial wound infections in two, neurological deterioration in one, temporary jaundice in one and implant failure requiring revision in one.

Conclusion: Single stage opening-closing wedge osteotomy is an effective method to correct severe kyphosis in healed spinal tuberculosis.