Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction
Abstract Background and purpose Several surgical procedures are used to treat tuberculous kyphosis. However, the treatment of extreme spinal kyphosis is challenging, and associated with various complications. Halo traction has been used as an adjunctive method in the treatment of severe spinal defor...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2022-11-01
|
| Series: | BMC Musculoskeletal Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12891-022-05974-7 |
| _version_ | 1811189438634524672 |
|---|---|
| author | Longtao Qi Yao Zhao Beiyu Xu Chunde Li Yu Wang |
| author_facet | Longtao Qi Yao Zhao Beiyu Xu Chunde Li Yu Wang |
| author_sort | Longtao Qi |
| collection | DOAJ |
| description | Abstract Background and purpose Several surgical procedures are used to treat tuberculous kyphosis. However, the treatment of extreme spinal kyphosis is challenging, and associated with various complications. Halo traction has been used as an adjunctive method in the treatment of severe spinal deformities. However, there are few reports about the effectiveness of halo-pelvic traction (HPT) for the treatment of extreme spinal kyphosis secondary to tuberculosis. This study evaluated the effectiveness of halo-pelvic traction followed by a posterior-only approach correction in the treatment of severe spinal kyphosis secondary to tuberculosis. Methods The records of 19 patients with severe spinal kyphosis secondary to tuberculosis were retrospectively reviewed. All 19 patients were treated with a two-stage approach: HPT combined with posterior fusion surgery by a posterior-only approach. Radiographic parameters were measured and evaluated. America Spinal Injury Association grade (ASIA), Scoliosis Research Society outcome (SRS-22) score, and complications were also evaluated. Results There were 9 males and 10 females, with an average age of 29.7 years at the time of surgery. The average HPT duration was 10.4 weeks. The mean kyphosis angle decreased from 131.40 ± 10.7° pre-traction to 77.1 ± 7.4° post-traction (P < 0.01). The traction correction rate was 41.3%. The mean postoperative kyphosis angle was 65.7 ± 8.5°, and the surgical correction rate was 8.7%. Of the total correction, 82.6% was the result of HPT. At a mean follow-up of 26.5 months, the average kyphosis correction loss was 2.9°. The mean sagittal balance was 11.1 ± 45.2 mm before traction, − 25.0 ± 37.4 mm after traction, 7.0 ± 13 mm after surgery, and 2.8 ± 9.6 mm at the final follow-up. The mean preoperative SRS-22 score was 3.0 and postoperative was 4.2 (P < 0.01). The neurological status of most patients was improved. The total complication rate was 15.7%, including 1 neurological and 2 non-neurological complications. Conclusions HPT is effective in the management of severe spinal kyphotic deformity secondary to tuberculosis. Preoperative HPT can greatly reduce global kyphosis, and the need for corpectomy. |
| first_indexed | 2024-04-11T14:35:58Z |
| format | Article |
| id | doaj.art-0f50e57974d54e849c931ce27fe698b5 |
| institution | Directory Open Access Journal |
| issn | 1471-2474 |
| language | English |
| last_indexed | 2024-04-11T14:35:58Z |
| publishDate | 2022-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Musculoskeletal Disorders |
| spelling | doaj.art-0f50e57974d54e849c931ce27fe698b52022-12-22T04:18:20ZengBMCBMC Musculoskeletal Disorders1471-24742022-11-012311910.1186/s12891-022-05974-7Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correctionLongtao Qi0Yao Zhao1Beiyu Xu2Chunde Li3Yu Wang4Department of Orthopaedics, Peking University First HospitalDepartment of Orthopaedics, Peking University First HospitalDepartment of Orthopaedics, Peking University First HospitalDepartment of Orthopaedics, Peking University First HospitalDepartment of Orthopaedics, Peking University First HospitalAbstract Background and purpose Several surgical procedures are used to treat tuberculous kyphosis. However, the treatment of extreme spinal kyphosis is challenging, and associated with various complications. Halo traction has been used as an adjunctive method in the treatment of severe spinal deformities. However, there are few reports about the effectiveness of halo-pelvic traction (HPT) for the treatment of extreme spinal kyphosis secondary to tuberculosis. This study evaluated the effectiveness of halo-pelvic traction followed by a posterior-only approach correction in the treatment of severe spinal kyphosis secondary to tuberculosis. Methods The records of 19 patients with severe spinal kyphosis secondary to tuberculosis were retrospectively reviewed. All 19 patients were treated with a two-stage approach: HPT combined with posterior fusion surgery by a posterior-only approach. Radiographic parameters were measured and evaluated. America Spinal Injury Association grade (ASIA), Scoliosis Research Society outcome (SRS-22) score, and complications were also evaluated. Results There were 9 males and 10 females, with an average age of 29.7 years at the time of surgery. The average HPT duration was 10.4 weeks. The mean kyphosis angle decreased from 131.40 ± 10.7° pre-traction to 77.1 ± 7.4° post-traction (P < 0.01). The traction correction rate was 41.3%. The mean postoperative kyphosis angle was 65.7 ± 8.5°, and the surgical correction rate was 8.7%. Of the total correction, 82.6% was the result of HPT. At a mean follow-up of 26.5 months, the average kyphosis correction loss was 2.9°. The mean sagittal balance was 11.1 ± 45.2 mm before traction, − 25.0 ± 37.4 mm after traction, 7.0 ± 13 mm after surgery, and 2.8 ± 9.6 mm at the final follow-up. The mean preoperative SRS-22 score was 3.0 and postoperative was 4.2 (P < 0.01). The neurological status of most patients was improved. The total complication rate was 15.7%, including 1 neurological and 2 non-neurological complications. Conclusions HPT is effective in the management of severe spinal kyphotic deformity secondary to tuberculosis. Preoperative HPT can greatly reduce global kyphosis, and the need for corpectomy.https://doi.org/10.1186/s12891-022-05974-7Spinal tuberculosisHalo-pelvic tractionSevere spinal deformity |
| spellingShingle | Longtao Qi Yao Zhao Beiyu Xu Chunde Li Yu Wang Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction BMC Musculoskeletal Disorders Spinal tuberculosis Halo-pelvic traction Severe spinal deformity |
| title | Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction |
| title_full | Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction |
| title_fullStr | Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction |
| title_full_unstemmed | Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction |
| title_short | Two-stage treatment for severe spinal kyphotic deformity secondary to tuberculosis: halo-pelvic traction followed by a posterior-only approach correction |
| title_sort | two stage treatment for severe spinal kyphotic deformity secondary to tuberculosis halo pelvic traction followed by a posterior only approach correction |
| topic | Spinal tuberculosis Halo-pelvic traction Severe spinal deformity |
| url | https://doi.org/10.1186/s12891-022-05974-7 |
| work_keys_str_mv | AT longtaoqi twostagetreatmentforseverespinalkyphoticdeformitysecondarytotuberculosishalopelvictractionfollowedbyaposterioronlyapproachcorrection AT yaozhao twostagetreatmentforseverespinalkyphoticdeformitysecondarytotuberculosishalopelvictractionfollowedbyaposterioronlyapproachcorrection AT beiyuxu twostagetreatmentforseverespinalkyphoticdeformitysecondarytotuberculosishalopelvictractionfollowedbyaposterioronlyapproachcorrection AT chundeli twostagetreatmentforseverespinalkyphoticdeformitysecondarytotuberculosishalopelvictractionfollowedbyaposterioronlyapproachcorrection AT yuwang twostagetreatmentforseverespinalkyphoticdeformitysecondarytotuberculosishalopelvictractionfollowedbyaposterioronlyapproachcorrection |