Retrospective analysis of deformed complex vertebral osteotomy in children with severe thoracic post-tubercular angular kyphosis

Background Many surgical options have been described to manage post-tubercular kyphosis, but the standard approach for treating severe post-tubercular angular kyphosis in children has not been established yet. The present study was performed to evaluate the safety and efficacy of deformed complex vertebral osteotomy (DCVO) for the treatment of severe thoracic post-tubercular angular kyphosis (> 70 degrees) in children. Methods Deformed complex vertebrae indicated that multiple deformed and fused vertebrae were usually involved with two or more vertebral bodies and the partial or total fusion of many segments' facet joints and intervertebral discs. Thus, DCVO indicated that a wider posterior wedge-shaped and three-column osteotomy was performed within deformed complex vertebrae to correct a more extensive range of angles. From 2010 to 2017, 15 children who suffered from severe thoracic post-tubercular angular kyphosis underwent DCVO. Deformed complex vertebrae involved two vertebral bodies in 9 patients and three vertebral bodies in 6 patients. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) were assessed preoperatively and at the final follow up. This was a retrospective study analysing the outcome after grade 4/5 spinal osteotomies in deformed complex vertebrae. Results The mean duration of surgery was 239 +/- 37.81 min. The average period of follow-up was 31.6 +/- 6.98 months. The preoperative mean kyphosis of deformed complex vertebrae was 83.39 degrees +/- 9.04 degrees; the mean thoracic kyphosis (TK) and lumbar lordosis (LL) were 81.09 degrees +/- 8.51 degrees and 80.51 degrees +/- 7.64 degrees, respectively; the mean sagittal vertical axis (SVA) was 3.83 cm +/- 1.43 cm. The postoperative mean kyphosis of deformed complex vertebrae was reduced to 19.98 degrees +/- 2.47 degrees (P < 0.001) with a mean kyphosis correction of 63.41 degrees; at the final follow up, it was 18.4 degrees +/- 2.29 degrees (P < 0.001) without obvious loss of correction. The postoperative mean TK, LL, and SVA were reduced to 24.05 degrees +/- 3.84 degrees, 46.9 degrees +/- 3.53 degrees, and 0.6 cm +/- 0.34 cm, respectively (P < 0.001 for all); and there was no obvious loss of sagittal alignment and balance at the final follow up (p = 0.982, p = 0.604, p = 0.754). Complicated with neural dysfunction preoperatively, 5 Frankel's grade D cases showed complete neurological recovery at final follow up. VAS score reduced from 3.6 +/- 1.18 to 0.87 +/- 0.64 (P < 0.001); and ODI score reduced from 22.21 +/- 6.93 to 5.02 +/- 2.6 (P < 0.001) at the final follow up. Conclusions DCVO was an individualized osteotomy for treating severe thoracic post-tubercular angular kyphosis in children and could be safe and effective in reducing the incidence of complications and significantly improving kyphosis correction.