Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis

Retrospective case analysis.

Tuberculosis spondylitis is a cause of sagittal imbalance and neurologic impairment. In this study, the result of decompression and closing wedge osteotomy with instrumented fusion performed in patients with tuberculous spondylitis were analyzed retrospectively.

Twelve patients with angular kyphotic deformity underwent decompression and closing wedge osteotomy with instrumented fusion between 2000 and 2004. Clinical and radiologic assessment was based on pain, functional and neurologic status, and radiologic measurements.

There were 7 men and 5 women with median age of 52 years (range, 24 to 76 y). The average follow-up period was 62 months (range, 48 to 70 mo). The radiologic involvement included the angle of kyphosis on the anteroposterior and lateral radiographs. The preoperative and postoperative clinical assessments were performed by the using Oswestry Disability Index. All patients were asked to rate their preoperative and postoperative pain measurement using a pain visual analog scale.

Visual analog scale scores improved from 5.8 in average (range, 4 to 8) to 2.2 in average (range, 1 to 4) and in the mean and Oswestry Disability Index from 54.2 (46 to 60) preoperatively to 15.2 (8 to 22) at the latest follow-up. Four patients presented neurologic findings. Three patients had improvement in their neurologic status, 1 patient did not improve and remained as American Spinal Injury Association (ASIA) grade C. Kyphotic deformity of the patients has improved from 51.1 to 23.2 degrees postoperatively. One of them has to be revised and instrumentation was extended to upper levels. Fusion was achieved at the last follow-up.

Despite developing pseudarthrosis secondary to implant failure in 1 case, we recommend debridement, closing wedge osteotomy, and posterior instrumented fusion to correct sagittal balance in tuberculous spondylitis.