Abstract
Purpose
The purpose of this study was to determine the clinical results of patients with late onset upper thoracic sharp Pott’s kyphosis and to predict the prognosis for Pott's paraplegics.
Method
The study included five patients who developed late onset upper thoracic (T1–T4) sharp Pott’s kyphosis /kyphoscoliosis within a period from 19 to 37 years after the active disease was healed. The kyphosis angle of the patients ranged from 95° to 105°. Among them, three patients suffered onset of paraplegia ranging from 26 to 31 years after spinal tuberculosis was healed. The duration of neurological deterioration before surgery ranged from four to five years. All patients underwent decompressive surgery with an attempt to correct the curve. Neurological status was evaluated using the ASIA impairment classification and the motor score.
Results
Postoperatively, kyphosis correction ranged from 20° to 30° for five patients. No neurological deficit occurred in two patients with normal neurological status. Two ASIA D paraplegics remained unchanged after surgery and no further improvement was found at one year follow-up. One ASIA C paralysis deteriorated neurologically to ASIA B after surgery and persisted to a deterioration of neurological status at one year follow–up.
Conclusion
Upper thoracic sharp Pott's kyphosis and neurological deficits occur progressively. The neurological recovery or improvement of Pott's paraplegics with upper thoracic severe sharp kyphosis results in poor prognosis after decompressive surgery.
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References
Ho W (1991) World tuberculosis toll on the rise. Asian Med News 3:9
Tuli SM (1995) Severe kyphotic deformity in tuberculosis of the spine. Int Orthop 19:327–331
Jain AK, Dhammi IK, Jain S et al (2010) Kyphosis in spinal tuberculosis—Prevention and correction. Indian J Orthop 44(2):127–136
Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913
Nigg AP, Schulze-Koops H, Wirth S et al (2008) Tuberculous spondylitis (Pott’s disease). Infection 36:293–294
Hodgson AR, Yau A, Kwon JS et al (1964) A clinical study of 100 consecutive cases of Pott's paraplegia. Clin Orthop Relat Res 36:128–150
Luk KDK (1999) Tuberculosis of the spine in the new millennium. Eur Spine J 8:338–345
Sai Kiran NA, Vaishya S, Kale SS et al (2007) Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine 6(4):320–326
Tuli SM (1975) Results of treatment of spinal tuberculosis by ‘middlepath’ regime. J Bone Joint Surg 57:13–23
Ditunno JF, Young W, Donovan WH et al (1994) The international standards booklet for neurological and functional classification of spinal cord injury. Paraplegia 32:70–80
Bilsel N (2000) Late onset Pott's paraplegia. Spinal Cord 38:669–674
Moon MS, Woo YK, Lee KS et al (1995) Posterior instrumentation and anterior interbody fusion for tuberculosis kyphosis of dorsal and lumbar spine. Spine 20:1910–1916
Moon MS, Moon JL, Moon YW et al (2003) Pott's paraplegia in patients with severely deformed dorsal or dorsolumbar spines: treatment and prognosis. Spinal Cord 41:164–171
Hsu LCS, Cheng CL, Leong JCY (1988) Pott's paraplegia of late onset, the cause of compression and results after anterior decompression. J Bone Joint Surg 70:534–538
Fountain SS, Hsu LC, Yau AC et al (1975) Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. J Bone Joint Surg Am 57A:1104–1107
Bailey HL, Gabrid M, Hodgson AR et al (1972) Tuberculosis of the spine in children. J Bone Joint Surg Am 54A:1613–1657
Schulitz KP, Kothe R, Leong JC (1997) Growth changes of solidly fused kyphosis bloc after surgery for tuberculosis. Spine 22:1150–1155
Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39(8):429–436
Jain AK, Maheshwari AV, Jena S (2007) Kyphus correction in spinal tuberculosis. Clin Orthop Relat Res 460:117–123
Moon MS (1997) Tuberculosis of the spine—controversies and a new challenge. Spine 22(15):1791–1797
Winter RB (1999) Major neurological complications in spinal deformity surgery: one surgeon's carrer experience. J Orthop Surg 7(2):81–88
Moon MS, Ha KY, Sun DH, Chung JH (1996) Pott's paraplegia 67 cases. Clin Orthop 323:122–128
Pattisson PR (1986) Pott's paraplegia: An account of the treatment of 89 consecutive patients. Paraplegia 24:77–91
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Zhang, Z. Late onset Pott’s paraplegia in patients with upper thoracic sharp kyphosis. International Orthopaedics (SICOT) 36, 381–385 (2012). https://doi.org/10.1007/s00264-011-1285-8
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DOI: https://doi.org/10.1007/s00264-011-1285-8