Journal Article Successful surgical correction of post-tubercular kyphosis by pedicle subtraction osteotomy: a case report

SUZUKI, Masahiro  ,  鈴木, 雅博  ,  ORITA, Sumihisa  ,  折田, 純久  ,  SAINOH, Takeshi  ,  西能, 健  ,  INAGE, Kazuhide  ,  稲毛, 一秀  ,  KUBOTA, Go  ,  久保田, 剛  ,  SHIGA, Yasuhiro  ,  志賀, 康浩  ,  YAMAUCHI, Kazuyo  ,  山内, かづ代  ,  EGUCHI, Yawara  ,  江口, 和  ,  AOKI, Yasuchika  ,  青木, 保親  ,  NAKAMURA, Junichi  ,  中村, 順一  ,  INOUE, Gen  ,  井上, 玄  ,  MIYAGI, Masayuki  ,  宮城, 正行  ,  SAKUMA, Yoshihiro  ,  佐久間, 詳浩  ,  OIKAWA, Yasuhiro  ,  及川, 泰宏  ,  NAKATA, Yukio  ,  中田, 幸夫  ,  TOYONE, Tomoaki  ,  豊根, 知明  ,  TAKAHASHI, Kazuhisa  ,  高橋, 和久  ,  OHTOR, Seiji  ,  大鳥, 精司

91 ( e )  , pp.e13 - e17 , 2015-06-01 , The Chiba Medical Society , 千葉医学会
Description
An 80-year-old woman presented with severe thoracolumbar kyphosis due to spinal tuberculosis with chronic low back pain and gait disturbance. Radiographs showed T9-L1 bony union in the anterior and posterior longitudinal ligaments. Rigid bony union of the L2 and L3 vertebral bodies, with trapezoid-shaped deformity, a sagittal vertical axis (SVA) of approximately 570 mm, and a severe pelvic posterior inclination, were also evident. No residual tuberculous disease was detected. The patient was treated with kyphoplasty, which included an L2 pedicle subtraction vertebral osteotomy (PSO), and T9-S1 fixation. The procedure yielded a 45° correction in the sagittal alignment and enhanced local stability, resulting in an SVA of 50 mm. Her post-operative lower back pain and the gait disturbance resolved. The osteotomy site showed sufficient bony union 8 months post-operatively. PSO yielded marked improvements and stability with no complications such as pseudoarthritis at the osteotomy site. Also her sagittal alignment was corrected to achieve adequate stability with sufficient activities of daily living and improved quality of life. Vertebral osteotomy on those with rigid deformity gives good and stable clinical outcome.
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