Summary
Almost 3% of cases of tuberculosis of the spine develop a severe kyphotic deformity. The patients at risk are those who developed the disease under the age of 10 years, who had involvement of three or more vertebral bodies and had lesions between C7 to L1. A severe kyphosis is more than a cosmetic disfigurement because nearly all such patients develop cardiopulmonary dysfunction, painful impingement between ribs and pelvis and compression of the spinal cord with paraplegia at an average of 10 years after the onset of the disease. Correction of the established deformity is difficult and dangerous. Anterior transposition of the cord does not always result in permanent neurological recovery, so it is imperative to diagnose and treat the condition either before bony destruction has occurred or when it is in an early phase. Those patients who are at risk of developing a severe deformity should be treated by posterior fusion of the spine.
Résumé
Près de 3% des tuberculoses du rachis s'accompagnent d'une cyphose sévère. Les patients à risques sont ceux dont la maladie a commencé dans la petite enfance (avant l'âge de 10 ans), qui ont une atteinte de 3 corps vertébraux ou plus avec une localisation entre C7 et L1. La cyphose importante ne doit pas être considérée seulement comme un trouble esthétique, puisque presque tous les patients vont développer dans un délai de 5 à 20 ans après le début de la déformation, des troubles cardio-pulmonaires, des douleurs par conflit costo-pelvien et des troubles neurologiques allant jusqu'à la paraplégie. La correction d'une déformation établie est difficile et dangereuse, la transposition antérieure de la moelle et des racines ne donne pas toujours un bon résultat sur les troubles neurologiques, aussi est-il impératif que le diagnostic et le traitement soient faits à une phase précoce de la maladie. Il faut traiter par arthrodèse rachidienne postérieure, les patients présentant des lésions à risques qui peuvent conduire à une cyphose importante.
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Tuli, S.M. Severe kyphotic deformity in tuberculosis of the spine. International Orthopaedics 19, 327–331 (1995). https://doi.org/10.1007/BF00181121
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DOI: https://doi.org/10.1007/BF00181121