Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis

Area of Science:

• Spine surgery
• Infectious disease of the spine
• Spinal deformity correction

Background:

• Tuberculosis spondylitis can lead to significant sagittal imbalance and neurological deficits.
• Angular kyphotic deformity is a common complication requiring surgical intervention.
• Effective surgical strategies are crucial for managing the sequelae of spinal tuberculosis.

Purpose of the Study:

• To retrospectively analyze the outcomes of decompression and closing wedge osteotomy with instrumented fusion in patients with tuberculous spondylitis.
• To evaluate the efficacy of this surgical approach in correcting sagittal imbalance and improving clinical status.
• To assess the impact on pain, functional capacity, and neurological function.

Main Methods:

• Retrospective case analysis of twelve patients (7 men, 5 women; median age 52 years) who underwent the procedure between 2000 and 2004.
• Preoperative and postoperative assessments included pain visual analog scale (VAS) and Oswestry Disability Index (ODI).
• Radiographic evaluation focused on kyphotic deformity measurements; neurological status was assessed using the American Spinal Injury Association (ASIA) scale.

Main Results:

• Significant improvement in pain (VAS: 5.8 to 2.2) and functional status (ODI: 54.2 to 15.2).
• Kyphotic deformity improved from an average of 51.1 degrees to 23.2 degrees.
• Neurological improvement was observed in three of four patients with preoperative deficits; fusion was achieved in all cases, with one requiring revision.

Conclusions:

• Decompression, closing wedge osteotomy, and posterior instrumented fusion are recommended for correcting sagittal imbalance in tuberculous spondylitis.
• This surgical technique demonstrates significant efficacy in improving pain, function, and deformity.
• While pseudarthrosis is a potential complication, the overall results support the procedure's effectiveness.