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

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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusion

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

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Acknowledgments

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

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Authors and Affiliations

  1. Department of Spinal Surgery, Xiangya Hospital of Central South University, Changsha, 410008, China

    Zhang Hong-Qi, Chen Yong, Huang Jia, Guo Chaofeng & Hu Xiongke

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  1. Zhang Hong-Qi
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  2. Chen Yong
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  3. Huang Jia
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  4. Guo Chaofeng
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  5. Hu Xiongke
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Correspondence to Zhang Hong-Qi.

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Hong-Qi, Z., Yong, C., Jia, H. et al. Modified pedicle subtraction osteotomies (mPSO) for thoracolumbar post-tubercular kyphosis in pediatric patients: retrospective clinical cases and review of the literature. Childs Nerv Syst 31, 1347–1354 (2015). https://doi.org/10.1007/s00381-015-2738-y

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  • DOI: https://doi.org/10.1007/s00381-015-2738-y

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