A Novel Surgical Strategy For Correcting Severe Angular Kyphosis Due To Pott’s Disease: Three Column Osteotomy In Non-lesioned Areas

Abstract

Abstract Severe sharp angular kyphosis due to Pott’s disease usually need surgical correction. Three column osteotomy performed in lesion area as well as apex area has been demonstrated useful to correct angular kyphosis. But the residual kyphosis may conspicuous and there is usually high rate of perioperative risk. To improve the correction effect and avoid high rate of risk, we designed a novel strategy that osteotomy in the non-lesioned vertebrae to correct severe angular kyphosis due to Pott’s disease.We retrospectively reviewed 16 patients who underwent the new surgical strategy that osteotomy in non-lesioned vertebra instead of lesioned areas in our hospital from 2016 to 2018. Radiographic parameters including angle of kyphosis and sagittal vertical axis (SVA) were recorded respectively at admission and final follow-up. Neurological improvement was measured according to the American Spine Injury Association (ASIA) classification. Operative time, blood loss, perioperative complications were also recorded. There were 6 male and 10 female patients. Their mean age was 30.7±11.41 years. The duration of follow-up ranged from 24 to 42 months. The mean operative time and blood loss were 492±127.3min and 1791±788.8 ml, respectively. Kyphosis angle was corrected from 97.6±14.6° to 28.8±18.70°. In two cases with lumbar lesions (L1-L5 and L2-S1，respectively), the lumbar lordosis was restored. The mean SVA was 6.7±3.58cm at admission, and 3.3±1.57cm at final follow-up. Neurological function improved in 6 cases, while it remained the same as before surgery in other 10 patients. The rate of complications including wound infection (1 case) and rod fracture (1 case at the 12 months after surgery) was approximately 11.8%. The new surgical strategy was effective and safe to correct severe angular kyphosis due to Pott’s disease. However, the surgical team should be experienced.