Child's Nervous System

, Volume 31, Issue 8, pp 1347–1354 | Cite as

Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature

  • Zhang Hong-QiEmail author
  • Chen Yong
  • Huang Jia
  • Guo Chaofeng
  • Hu Xiongke
Original Paper



The purpose of this study was to evaluate the clinical and radiographic outcomes of modified pedicle subtraction osteotomy (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients.


From January 2008 to August 2012, 26 consecutive pediatric patients with thoracolumbar post-tubercular kyphosis underwent modified pedicle subtraction osteotomy (mPSO). The clinical and radiologic outcomes were analyzed preoperatively, postoperatively, and at the last follow-up.


Twenty-six patients with thoracolumbar post-tubercular kyphosis underwent mPSO. The average operation time was 256 min (188~314 min). The mean follow-up was 41 months (18~56 months). The mean estimated blood loss was 870 ml (620 ~ 1020 ml). The thoracolumbar kyphotic angle ranged from 51° to 79° before operation, 60.6° in average. The mean thoracolumbar kyphotic Cobb angle was 19.7° after operation, with a mean correction of 40.9°. The C7 sagittal plumb line was 3.8 cm after operation, comparing to the 10.5 cm preoperative. The mean preoperative angle of thoracic kyphosis (TK) was 9.9° ± 1.2° and increased to 11.8° ± 1.4°, postoperatively. Lumbar lordosis (LL) improved from −22.8° ± 4.9° preoperative to −17.8° ± 2.1° postoperative. Visual analogue scale (VAS) was 8.7 ± 1.1 preoperative and 1.2 ± 0.4 postoperative, respectively. The mean Oswestry Disability Index (ODI) improved from 49.2 ± 5.3 before surgery to 10.8 ± 3.3 postoperative (P < 0.01). All patients received good bone healing, no significant loss of correction angle. Most patients (24/26) considered pain and exterior was significantly improved.


Modified pedicle subtraction osteotomy (mPSO) is effective and reliable for thoracolumbar post-tubercular kyphosis in pediatric patients.


Modified pedicle subtraction osteotomy (mPSO) Pediatric Thoracolumbar Post-tubercular Kyphosis 



The study is supported by the National Natural Science Foundation of China (NO 81271940) and Natural Science Foundation of Hunan (NO 12JJ2043).


  1. 1.
    Moon M-S (1997) Tuberculosis of the spine: controversies and a new challenge. Spine 22:1791–1797PubMedCrossRefGoogle Scholar
  2. 2.
    Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19:327–331PubMedCrossRefGoogle Scholar
  3. 3.
    Moon MS, Kim I, Woo YK, Park YO (1987) Conservative treatment of tuberculosis of the thoracic and lumbar spine in adults and children. Int Orthop 11:315–322PubMedCrossRefGoogle Scholar
  4. 4.
    Rajasekaran S (2001) The natural history of post-tubercular kyphosis in children. Radiological signs which predict late increase in deformity. J Bone Joint Surg Br 83:954–962PubMedCrossRefGoogle Scholar
  5. 5.
    Rajasekaran S (2012) Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 36:359–365PubMedCentralPubMedCrossRefGoogle Scholar
  6. 6.
    Cho K-J, Bridwell KH, Lenke LG, Berra A, Baldus C (2005) Comparison of Smith-Petersen versus pedicle subtraction osteotomy for the correction of fixed sagittal imbalance. Spine 30:2030–2037PubMedCrossRefGoogle Scholar
  7. 7.
    Kim K-T, Lee S-H, Suk K-S, Lee J-H, Jeong B-O (2012) Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies: a retrospective review of 140 patients. Spine 37:1667–1675PubMedCrossRefGoogle Scholar
  8. 8.
    Bridwell KH, Lewis SJ, Edwards C, Lenke LG, Iffrig TM, Berra A, Baldus C, Blanke K (2003) Complications and outcomes of pedicle subtraction osteotomies for fixed sagittal imbalance. Spine 28:2093–2101PubMedCrossRefGoogle Scholar
  9. 9.
    Lenke LG, O’Leary PT, Bridwell KH, Sides BA, Koester LA, Blanke KM (2009) Posterior vertebral column resection for severe pediatric deformity: minimum two-year follow-up of thirty-five consecutive patients. Spine 34:2213–2221PubMedCrossRefGoogle Scholar
  10. 10.
    Suk S-I, Kim J-H, Kim W-J, Lee S-M, Chung E-R, Nah K-H (2002) Posterior vertebral column resection for severe spinal deformities. Spine 27:2374–2382PubMedCrossRefGoogle Scholar
  11. 11.
    Smith-Petersen M, Larson CB, Aufranc OE (1945) Osteotomy of the spine for correction of flexion deformity in rheumatoid arthritis. J Bone Joint Surg Am 27:1–11Google Scholar
  12. 12.
    Thomasen E (1985) Vertebral osteotomy for correction of kyphosis in ankylosing spondylitis. Clin Orthop Relat Res 194:142–152PubMedGoogle Scholar
  13. 13.
    Shimode M, Kojima T, Sowa K (2002) Spinal wedge osteotomy by a single posterior approach for correction of severe and rigid kyphosis or kyphoscoliosis. Spine 27:2260–2267PubMedCrossRefGoogle Scholar
  14. 14.
    Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Murakami H (2001) Closing-opening wedge osteotomy to correct angular kyphotic deformity by a single posterior approach. Spine 26:391–402PubMedCrossRefGoogle Scholar
  15. 15.
    Chunguang Z, Limin L, Rigao C, Yueming S, Hao L, Qingquan K, Quan G, Tao L, Jiancheng Z (2010) Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis. J Pediatr Orthop 30:271–276PubMedCrossRefGoogle Scholar
  16. 16.
    Moon M-S, Woo Y-K, Lee K-S, Ha K-Y, Kim S-S, Sun D-H (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916PubMedCrossRefGoogle Scholar
  17. 17.
    Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellation osteotomy in the treatment of posttuberculous kyphosis. J Spinal Disord Tech 20:209–215PubMedCrossRefGoogle Scholar
  18. 18.
    Kalra K, Dhar S, Shetty G, Dhariwal Q (2006) Pedicle subtraction osteotomy for rigid post-tuberculous kyphosis. J Bone Joint Surg Br 88:925–927PubMedCrossRefGoogle Scholar
  19. 19.
    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 19:583–592PubMedCentralPubMedCrossRefGoogle Scholar
  20. 20.
    Hamzaoglu A, Alanay A, Ozturk C, Sarier M, Karadereler S, Ganiyusufoglu K (2011) Posterior vertebral column resection in severe spinal deformities: a total of 102 cases. Spine 36:E340–E344PubMedGoogle Scholar
  21. 21.
    Bridwell KH, Lewis SJ, Rinella A, Lenke LG, Baldus C, Blanke K (2004) Pedicle subtraction osteotomy for the treatment of fixed sagittal imbalance. Surgical technique. J Bone Joint Surg Essent Surg Tech 86:44–49Google Scholar
  22. 22.
    Kim K-T, Suk K-S, Cho Y-J, Hong G-P, Park B-J (2002) Clinical outcome results of pedicle subtraction osteotomy in ankylosing spondylitis with kyphotic deformity. Spine 27:612–618PubMedCrossRefGoogle Scholar
  23. 23.
    Heary RF, Bono CM (2006) Pedicle subtraction osteotomy in the treatment of chronic, posttraumatic kyphotic deformity. J Neurosurg Spine 5:1–8PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Zhang Hong-Qi
    • 1
    Email author
  • Chen Yong
    • 1
  • Huang Jia
    • 1
  • Guo Chaofeng
    • 1
  • Hu Xiongke
    • 1
  1. 1.Department of Spinal SurgeryXiangya Hospital of Central South UniversityChangshaChina

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