Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients.

The correction of severe post-tubercular kyphosis (PTK) is complex and has the disadvantage of being multiple staged with a high morbidity. Here, we describe the procedure and results of closing-opening osteotomy for correction of PTK which shortens the posterior column and opens the anterior column appropriately to correct the deformity without altering the length of the spinal cord. Seventeen patients with PTK (10 males; 7 females) with an average age of 18.3 +/- 10.6 years (range 4-40 years) formed the study group. There were ten thoracolumbar, one lumbar and six thoracic deformities. The number of vertebrae involved ranged from 2 to 5 (average 2.8). Preoperative kyphosis averaged 69.2 degrees +/- 25.1 degrees (range 42 degrees -104 degrees ) which included ten patients with deformity greater than 60 degrees . The average vertebral body loss was 2.01 +/- 0.79 (range 1.1-4.1). The neurological status was normal in 13 patients, Frankel's grade D in three patients and grade C in one. Posterior stabilization with pedicle screw instrumentation was followed by a preoperatively calculated wedge resection. Anterior column reconstruction was performed using rib grafts in four, tricortical iliac bone graft in five, cages in six, and bone chips alone and fibular graft in one patient each. Average operating time was 280 min (200-340 min) with an average blood loss of 820 ml (range 500-1,600 ml). The postoperative kyphosis averaged 32.4 degrees +/- 19.5 degrees (range 8 degrees -62 degrees ). The percentage correction of kyphosis achieved was 56.8 +/- 14.6% (range 32-83%). No patient with normal preoperative neurological status showed deterioration in neurology after surgery. The last follow-up was at an average of 43 +/- 4 months (range 32-64 months). The average loss of correction at the last follow-up was 5.4 degrees (range 3 degrees -9 degrees ). At the last follow-up, the mean preoperative pain visual analogue scale score decreased significantly from 9.2 (range 8-10 points) to 1.5 (range 1-2 points). There was also a significant decrease in mean preoperative Oswestry's Disability Index from 56.4 (range 46-68) to 10.6 (range 6-15). Complications were superficial wound infections in two, neurological deterioration in one, temporary jaundice in one and implant failure requiring revision in one. Single-stage closing-opening wedge osteotomy is an effective method to correct severe PTK. The procedure has the advantage of being a posterior only, single-stage correction, which allows for significant correction with minimal complications.