Clinical Evaluation of Sp Tb

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J Neurosurg: Spine / Volume 16 / April 2012

J Neurosurg Spine 16:351358, 2012

351

POST-TUBERCULOSIS kyphosis can result when theanterior column becomes structurally incompe-tent after the destruction of infected vertebrae. In

children, progressively severe kyphosis can also developwith ongoing spinal growth, particularly when multiplevertebrae are involved. The kyphotic deformity can besignicant in many cases.

Clinical and radiographic evaluation of posterior surgical

correction for the treatment of moderate to severepost-tuberculosis kyphosis in 36 cases with a minimum2-year follow-up

Clinical article

YANZENG, M.D.,1ZHONGQIANGCHEN, M.D.,1QIANGQI, M.D.,1ZHAOQINGGUO, M.D.,1WEISHILI, M.D.,1CHUIGUOSUN, M.D.,1ANDANDREWP. WHITE, M.D.2

1Orthopedic Department, Peking University 3rd Hospital, Beijing, China; and 2Harvard Medical School, Carl

J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Object.The object of this study was to compare the clinical and radiographic outcomes of 36 patients with post-tuberculosis kyphosis who underwent one of two types of osteotomy.

Methods.Each patient underwent single-stage correction via a posterior surgical approach. A modied pediclesubtraction osteotomy (mPSO) was performed when the kyphotic deformity was less than 70(7 cases), whereas aposterior vertebral column resection (VCR) was performed when the kyphotic deformity exceeded 70(29 cases).Full-length standing radiographs were obtained before surgery and at follow-up visits. These images were used tomeasure the kyphosis angle; sagittal alignment of the lumbar, thoracic, and cervical regions; and sagittal balance ofthe spine. Back pain was rated using the visual analog scale (VAS), and neurological function was classied basedon the American Spinal Injury Association (ASIA) grading system. Each patients overall satisfaction with surgicaltreatment was measured with the Patient Satisfaction Index. For purposes of comparison, patients were studied in 2groups based on the region of their kyphotic apex. Half of the cohort had apical kyphosis in the lower thoracic spineor thoracolumbar junction (TL group). Using both radiographic and clinical assessments, the authors compared thisgroup with the other half of the patients who had apical kyphosis in the upper to mid thoracic spine (MT group).

Results.The cohort included 15 males and 21 females, with an average age of 34 years at the time of surgery.

The minimum follow-up was 24 months, and the mean follow-up was 31 months. Following surgery, kyphosis acrossthe treated segments was reduced by an average of 60. Lumbar lordosis also improved by an average of 24, andthoracic kyphosis improved by an average of 20. Both back pain and neurological function improved after surgicaltreatment. There was a 67% improvement in VAS scores, and 13 of the 36 patients had improvement in their ASIAgrade. The 2 surgical procedures used for deformity correction (mPSO and VCR) demonstrated comparable radio-graphic and clinical results. Note, however, that differences were found in both radiographic and clinical outcomesin comparing patients who had lower thoracic or thoracolumbar (TL group) versus upper to midthoracic (MT group)apical kyphosis.

Conclusions.Posterior tubercular kyphosis can be effectively improved through corrective surgery, and de-formity correction can be accompanied by improvement in clinical symptoms. When appropriately selected, boththe mPSO and the VCR can be expected to yield satisfactory reduction of post-tuberculosis kyphotic deformities.Differences in radiographic and clinical outcomes should be anticipated, however, when treating such deformities indifferent regions of the spine.(http://thejns.org/doi/abs/10.3171/2011.12.SPINE11568)

KEYWORDS post-tuberculosis kyphosis moderate to severe kyphosis

kyphosis correction posterior corrective surgery Pott disease degenerative disease

Abbreviations used in this paper:ASIA = American Spinal InjuryAssociation; mPSO = modified pedicle subtraction osteotomy; PSI= Patient Satisfaction Index; VAS = visual analog scale; VCR =vertebral column resection.

This article contains some figures that are displayed in coloronline but in black and white in the print edition.


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352 J Neurosurg: Spine / Volume 16 / April 2012

Patients with signicant kyphosis typically presentwith cosmetic and functional problems related to the bio-mechanical changes associated with the kyphosis. The in-uence of spinal balance on function and quality of lifeis well established.1,9Substantial back pain and functionaldisability are common in patients with kyphosis.14Many

patients with post-tuberculosis kyphosis also present withneurological symptoms. These symptoms may be relatedto spinal cord compression or over-distraction of the cordover the kyphotic deformity. When symptoms related tosignicant post-tuberculosis deformities cannot be ad-equately managed conservatively, surgical correction maybe required.

Since post-tuberculosis kyphosis is one of the mostsevere types of spinal kyphosis, surgical correction maybe associated with signicant risks and challenges. Avariety of deformity correction techniques have been re-ported.5,12,13,16,17,19 The majority of these reports focus onimproving deformity correction and reducing surgicalcomplications. However, surgical decision making, partic-

ularly as regards the post-tuberculosis deformities, remainsa challenge.Because of the uncertainty associated with surgical

decision making, we compared 2 posterior surgical cor-rection procedures used in a cohort of patients with post-tuberculosis kyphosis. The surgical procedureeither anmPSO or a posterior VCRwas selected based on theseverity of the kyphosis. We measured radiographic andclinical results to compare patient outcomes in an effort toguide future care.

Methods

Clinical Data

Between July 2005 and September 2009, 36 patients(15 male and 21 female) with post-tuberculosis kyphosisunderwent posterior surgical correction in a single medicalcenter in Beijing. All patients had a history of spinal tuber-culosis and had previously received chemotherapy duringthe active stage of their vertebral tuberculosis infection.The average patient age at the time of surgery was 34.2years old (range 1356 years). All patients had a kyphoticangle >50. In 18 cases, the apex of the kyphosis was atT-10 or below, within the lower thoracic spine or thoraco-lumbar junction (TL group). In the remaining 18 cases, thekyphotic apex was above T-10, in the upper to midthoracicspine (MT group). Patients presented with lower extremityneurological symptoms alone (15 cases), back pain alone (4cases), both neurological symptoms and back pain (9 cases),

or with deformity-related cosmetic concerns not associatedwith pain or neurological symptoms (8 cases). All of thesymptomatic patients had undergone ineffective conserva-tive treatment for at least 6 months. All of the asymptom-atic patients had had severe kyphosis (>90degrees) for atleast 5 years. To prevent a recurrence of active tuberculousinfection, all patients were prescribed oral medications ofcombined isoniazid, ethambutol, and rifampicin from 2weeks before surgery to 6 months after surgery.

Surgical Procedure

Each patient underwent posterior surgical treatment

alone via one of two surgical methods. The method was se-lected preoperatively based solely on the severity of the ky-phosis. For patients with kyphosis less than 70, an mPSOwas used. This procedure (Fig. 1 upper) includes the sameposterior element resection as a traditional PSO but aug-ments the traditional closing wedge osteotomy with open-

ing (lengthening) of the anterior column.16An interbodydevice is used to maintain the anterior column opening inthis case. For patients with kyphosis more than 70, a VCRwas used. In the VCR, a dual-axis rotation correction isperformed to maximize correction (Fig. 1 lower). In ourcohort, the 7 patients with kyphosis less than 70were as-signed to mPSO and the 29 patients with kyphosis exceed-ing 70were assigned to VCR.

After inducing general endotracheal anesthesia, thepatient was placed prone. Care was taken to monitor andmaintain normal blood pressure during the operation toreduce the risk of spinal cord ischemia. Intraoperative neu-romonitoring was used for each case, including recordingof somatosensory evoked potentials and transcranial motor

evoked potentials. The posterior elements were exposed,and bilateral pedicle screws were placed at 2, 3, or 4 ver-tebrae above and below the apex of the kyphosis. For pa-tients undergoing mPSO, 2 or 3 vertebrae would typicallybe instrumented on either side of the apex. For patientsundergoing VCR, 3 or 4 vertebrae would be instrument-ed above and below the apex of the kyphosis. The PSOor VCR was then performed. After complete separation ofcephalic and caudal segments, deformity correction wasundertaken. Care was taken to maintain appropriate laxityof the spinal cord during the correction procedures. Forthe mPSO corrections, an interbody cage with bone graftwas placed anteriorly at the level of the osteotomy to aug-ment the correction before closing the posterior elements

(Fig. 1 upper). For the VCR corrections, dual axis rotationwas used, and titanium mesh packed with autologous bonegraft was placed into the osteotomy gap for reconstructionof the anterior column (Fig. 1 lower).

Radiographic Evaluation

All patients underwent standing full-length spine ra-diography before surgery and at each postoperative fol-low-up. The sagittal plane balance was evaluated, and thekyphosis angle, lumbar lordosis, thoracic kyphosis, andcervical lordosis were measured in each case.

Overall sagittal plane balance was measured usingthe C-7 plumb line on full-length standing lateral spineradiographs. The horizontal distance from the C-7 plumb

line to the posterior-superior corner of S-1 or the sacralpromontory was measured (Fig. 2). Negative sagittal bal-ance was noted when the C-7 plumb line fell posterior tothe posterior-superior corner of S-1, and positive sagittalbalance was described as the C-7 plumb line falling ante-rior to the sacral promontory. In our study, normal sagit-tal balance was designated when the C-7 plumb line fellbetween the posterior-superior corner of S-1 and the sacralpromontory.1,9

The kyphosis angle was dened on lateral standing ra-diographs as the angle between the superior endplate of therst morphologically normal vertebra above the deformity


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and the inferior endplate of the rst morphologically nor-mal vertebra below the deformity (Fig. 2). Lumbar lordosiswas dened as the angle between the superior endplate of

L-1 and the superior endplate of S-1 on lateral standingradiographs. If the apex of the kyphosis involved an upperlumbar segment, the angle between the superior endplate ofthe rst normal vertebra below the deformity and the supe-rior endplate of S-1 was used to measure lumbar lordosis,in lieu of the angle between L-1 and S-1. Thoracic kyphosiswas dened as the angle between the superior endplate ofT-1 and the inferior endplate of T-12. If the upper thoracicspine was not clearly visible, the angle between the supe-rior endplate of T-4 and the inferior endplate of T-12 wasmeasured. If the apex of the kyphosis involved the lowerthoracic segment (caudal to T-10), the rst normal vertebra

above the deformity was used instead of T-12. In cases inwhich the apex of the kyphosis was above T-10, we couldnot measure thoracic kyphosis. In total, 18 cases accom-

modated the measurement of thoracic kyphosis before andafter surgery. Cervical lordosis was dened as the anglebetween the superior endplate of C-3 and the inferior end-plate of C-7 on lateral radiographs.

Clinical Evaluation

Back pain was measured using the VAS before surgeryand at follow-up visits. Neurological function was evalu-ated using the ASIA grading system. The PSI, the patientsatisfaction subscale that was part of the North AmericanSpine Society Lumbar Spine Outcome Assessment, wasused to evaluate patient satisfaction with treatment.7

FIG. 1. Images depicting the 2 osteotomies used to treat post-tuberculosis kyphosis, accompanied by deformity correctionand reconstruction techniques. Upper:The mPSO is depicted. After pedicle screw instrumentation is placed above and belowthe planned osteotomy segment, a traditional pedicle subtraction is performed. The correction maneuver involves the traditionalclosing (shortening) of the posterior column and also introduces an opening (lengthening) of the anterior column. Lengthening ofthe anterior column improved the efficiency of the traditional correction and is maintained with an interbody device placed at theanterior aspect of the osteotomy. Lower:The VCR is depicted. This VCR takes advantage of dual axial rotation cor rection andwas used for correcting the most severe kyphotic deformities in our cohort. After placing pedicle screw instruments several seg-ments above and below the planned osteotomy, the entirety of the deformed segment is resected. The resection often includesmore than 1 vertebra, and the posterior elements cannot be closed after correction. Printed wi th the permission of Z. Chen, 2011.


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For purposes of comparison, the patients were catego-rized into 2 groups. One group had a kyphotic apex in thelower thoracic spine or thoracolumbar junction at or belowT-10 (TL group, 18 cases). The second group had the apexof the kyphosis in the upper to midthoracic spine, with thekyphotic apex above T-10 (MT group, 18 cases). Radio-

graphic and clinical evaluations were performed in bothof the groups.

Results

The average preoperative kyphosis angle was 89.3(range 54130). Preoperative thoracic kyphosis in ourcohort was less than the normal thoracic kyphosis,15aver-aging -8.6 (range -39 to 5). The average lumbar lordosiswas 72 (range 37 to 113), which was greater than nor-mal.11The average cervical lordosis was 6.5 (range -24to 29). The average preoperative C-7 plumb line fell 16.7mm posterior to the posterior-superior corner of S-1 (range-125 to 65 mm). Negative sagittal balance was demonstrat-

ed in 17 cases, with an average posterior shift of 44.6 mm.Sagittal plane balance was well maintained in 14 cases.Positive sagittal balance was found in 5 cases, with an av-erage anterior shift of 31.4 mm. The radiographic measure-ments before surgery are listed in Table 1.

The average VAS score for back pain was 2.0 in ourcohort, including the patients who had no back pain and re-ported a VAS score of 0 before surgery. Patients with nor-mal sagittal balance reported an average preoperative VASscore of 1.6; those with negative sagittal balance, a score of2.6; and those with positive sagittal balance, a score of 1.2.This difference in preoperative VAS scores based on sagit-tal balance was not statistically signicant (p >0.1). Thepreoperative ASIA grade for neurological functions was E

in 12 cases, D in 16, and C in 8 (Table 1).After surgery, patients were followed up for a mini-mum of 2 years, with an average follow-up of 31.3 months(range 2460 months). The kyphosis angle decreased to29.3 on average following surgical correction, with acorrection rate of 67.2%. The thoracic kyphosis angle im-proved postoperatively to 11.7on average, and the averagelumbar lordosis angle improved to 47.6(Table 1). Thesepreoperative to postoperative spinal alignment changeswere statistically signicant (p


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were also found to have improved neurological functionfollowing surgical treatment. The postoperative ASIAgrade was E in 21 cases, D in 11, and C in 4 (Table 1).

Patient satisfaction with surgery was generally favor-able. The patients in 22 cases were completely satisedwith surgery and those in 10 cases were partially satis-ed. This nding represented an overall satisfaction rateof 88.9% and a complete satisfaction rate of 61.1%. Thepatients who were completely satised had an average ky-phosis angle of 23.9 after surgery, while the remainingpatients had an average postoperative kyphosis angle of37.7, which represented a statistically signicant differ-ence between the 2 groups (p


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lead to over-shortening of the spinal cord, increasing therisk of iatrogenic neurological injury. For these reasons,many authors have suggested that posterior closing oste-otomies should be limited to treating kyphotic deformi-ties less than 40.6,8,13Indeed, prior attempts to treat severepost-tuberculosis kyphotic deformities by using posteriorclosing wedge osteotomies were difcult and inadequate.

Post-tuberculosis kyphosis typically involves multiplevertebral levels and is frequently associated with a signi-cant disparity between the height of the anterior and poste-rior columns. For this reason, in part, the anterior columnoften must be completely resected to achieve adequate cor-rection. In a previous experience, posterior closing wedgeosteotomy (PSO) was associated with 2.5 of correctionper mm of posterior closing, with a maximum correctionof 45. However, our mPSO, which augments the correc-tion by lengthening the anterior column, was shown to bemore efcient than this, with a mean angle of correctionof 6.2 per mm of posterior closing.10In prior series, wealso demonstrated a high degree of kyphosis correction viaeither mPSO or VCR while preserving or improving spinalcord function.5,16

Patients in the current series all had post-tuberculosiskyphosis exceeding 50. Each of these deformities was

adequately corrected with either mPSO or VCR. It is im-portant to note, however, that there is a substantial risk ofcomplications associated with these procedures. Signi-cant complications were seen in our patients, particularlyassociated with VCR. The majority of patients (29 of 36)were treated with VCR for the more severe kyphotic defor-mities, all exceeding 70. We reported CSF leakage, nerveroot injury, transient paralysis, and pseudarthrosis in thepatients who underwent correction via VCR. Careful vigi-lance should be maintained when treating these patientswith severe focal kyphosis, as they do have a high risk ofcomplications, including neurological injuries, during sur-gical correction.

Post-tuberculosis kyphosis most frequently affects the

thoracolumbar junction, followed by the middle and lower

thoracic spine. In this study, we categorized patients into2 groups according to the region of their kyphotic apex.The patients with apical kyphosis above T-10 (MT group)reported less back pain than the patients with thoracolum-bar kyphosis (TL group). This may be related to the impactof the deformity on lumbar lordosis. It may also be relatedto the stabilizing effect of the thorax in the patients withkyphosis above T-10. Preoperative neurological functionwas worse in the MT group, which may be related to thesensitivity of the thoracic spinal cord to either direct com-pression or tension over the kyphotic deformity. Follow-ing surgery, neurological function was improved in bothgroups, but greater improvements were seen in the patientswith post-tuberculosis kyphosis above T-10.

The radiographic and clinical results were good in thisseries of patients treated with surgical correction. The over-all satisfaction rate (PSI) was 88.9%, and the complete sat-isfaction rate was 61.1%. With regard to patient satisfactionoutcomes, we noted that the average postoperative kypho-sis of the completely satised patients was signicantlybetter than that of the remaining patients who reportedrelatively less satisfaction. This nding supports the priorclaim that improvement in clinical symptoms is related tothe adequacy of deformity correction and the appropriate

restoration of sagittal balance. This nding may also reectthe patients appreciation for their cosmetic improvementafter correction of this severe deformity.

Conclusions

Posterior tubercular kyphosis can be effectively im-proved through corrective surgery, and deformity cor-rection can be accompanied by improvement in clinicalsymptoms. When appropriately selected, both the mPSOand the VCR can be expected to yield satisfactory reduc-tion of post-tuberculosis kyphotic deformities. Differencesin radiographic and clinical outcomes should be antici-pated, however, when treating such deformities in different

regions of the spine.

TABLE 4: Radiographic measurements as an average before and after surgery, categorized by anatomical region of

the post-tuberculosis deformity*

Group

No. of

Cases

Kyphotic Angle () Lumbar Lordosis () Cervical Lordosis () Sagittal Balance (mm)

BS At FU BS At FU BS At FU BS At FU

TL 18 92.6

25.1 25.6

13.7 78.0

22.2 46.9

12.1 0.9

17.7 -

1.1

10.7 -

8.7

37.0 -

4.7

10.2MT 18 85.9 20.7 33.018.1 66.1 17.1 48.412.4 10.9 14.0 9.6 14.2 -24.7 35.5 -12.0 23.1

* MT = kyphosis in upper or midthoracic spine (above T-10); TL = kyphosis in the thoracolumbar region (T-10 and below).

TABLE 5: Clinical measurements are presented before and after surgery, categorized by the anatomical region of the

post-tuberculosis deformity

Group No. of Cases

Back Pain VAS Score* ASIA Grade (no. of cases)

BS At FU

E D C

BS At FU BS At FU BS At FU

TL 18 3.0 3.2 0.9 1.6 9 11 5 5 4 2

MT 18 1.1 2.3 0.4 0.9 3 10 11 6 4 2

* The VAS scores are presented as an average of all patients in each category.


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Disclosure

The authors report no conflict of interest concerning the mate-rials or methods used in this study or the findings specified in thispaper.

Author contributions to the study and manuscript preparationinclude the following. Conception and design: Chen. Acquisitionof data: Zeng, Qi, Guo, Li, Sun. Analysis and interpretation of data:Zeng. Drafting the article: Zeng. Critically revising the article: allauthors. Reviewed submitted version of manuscript: all authors.Approved the final version of the manuscript on behalf of all authors:Chen. Statistical analysis: Zeng. Study supervision: Chen.

References

1. Booth KC, Bridwell KH, Lenke LG, Baldus CR, Blanke KM:Complications and predictive factors for the successful treat-ment of atback deformity (xed sagittal imbalance). Spine(Phila Pa 1976)24:17121720, 1999

2. Bridwell KH, Lewis SJ, Lenke LG, Baldus C, Blanke K: Pediclesubtraction osteotomy for the treatment of xed sagittal imbal-ance. J Bone Joint Surg Am85-A:454463, 2003

3. Chen IH, Chien JT, Yu TC: Transpedicular wedge osteotomyfor correction of thoracolumbar kyphosis in ankylosing spon-dylitis: experience with 78 patients. Spine (Phila Pa 1976)26:E354E360, 2001

4. Chen Z, Dang G, Guo Z, Ji L, Qi Q: [Inuence of solid tho-racolumbar kyphosis on lumbar spine and surgical treatment.]Zhonghua Wai Ke Za Zhi38:824826, 2000 (Chinese)

5. Chen Z, Zeng Y, Li W, Guo Z, Qi Q, Sun C: Apical segmentalresection osteotomy with dual axial rotation corrective tech-nique for severe focal kyphosis of the thoracolumbar spine.Clinical article. J Neurosurg Spine14:106113, 2011

6. Chen ZQ, Li WS, Guo ZQ, Qi Q, Dang GT: [Surgical correctionof post-traumatic kyphosis of thoracolumbar spine.] ZhonghuaWai Ke Za Zhi43:201204, 2005 (Chinese)

7. Daltroy LH, Cats-Baril WL, Katz JN, Fossel AH, Liang MH:The North American spine society lumbar spine outcome as-sessment instrument: reliability and validity tests. Spine (PhilaPa 1976)21:741749, 1996

8. Gertzbein SD, Harris MB: Wedge osteotomy for the correctionof post-traumatic kyphosis. A new technique and a report of

three cases. Spine (Phila Pa 1976)17:374379, 1992 9. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S,

Schwab F: The impact of positive sagittal balance in adult spi-nal deformity. Spine (Phila Pa 1976)30:20242029, 2005

10. Hao CK, Li WS, Chen ZQ: The height of the osteotomy and

the correction of the kyphotic angle in thoracolumbar kyphosis.Chin Med J (Engl)121:19061910, 2008

11. Jackson RP, McManus AC: Radiographic analysis of sagittalplane alignment and balance in standing volunteers and pa-tients with low back pain matched for age, sex, and size. A pro-spective controlled clinical study. Spine (Phila Pa 1976)19:16111618, 1994

12. Kawahara N, Tomita K, Baba H, Kobayashi T, Fujita T, Mu-rakami H: Closing-opening wedge osteotomy to correct angu-lar kyphotic deformity by a single posterior approach. Spine

(Phila Pa 1976)26:391402, 200113. Lehmer SM, Keppler L, Biscup RS, Enker P, Miller SD, SteffeeAD: Posterior transvertebral osteotomy for adult thoracolum-bar kyphosis. Spine (Phila Pa 1976)19:20602067, 1994

14. Malcolm BW, Bradford DS, Winter RB, Chou SN: Post-trau-matic kyphosis. A review of forty-eight surgically treated pa-tients. J Bone Joint Surg Am63:891899, 1981

15. Propst-Proctor SL, Bleck EE: Radiographic determination oflordosis and kyphosis in normal and scoliotic children. J Pedi-atr Orthop3:344346, 1983

16. Qi Q, Chen ZQ, Guo ZQ, Li WS: [New type spinal osteotomywith cage inserting anteriorly and closing posteriorly to cor-rect thoracolumbar kyphosis by a single posterior approach.]Zhonghua Wai Ke Za Zhi44:551555, 2006 (Chinese)

17. Rajasekaran S, Vijay K, Shetty AP: Single-stage closing-open-ing wedge osteotomy of spine to correct severe post-tubercularkyphotic deformities of the spine: a 3-year follow-up of 17 pa-tients. Eur Spine J19:583592, 2010

18. Thiranont N, Netrawichien P: Transpedicular decancellationclosed wedge vertebral osteotomy for treatment of xed exiondeformity of spine in ankylosing spondylitis. Spine (Phila Pa1976)18:25172522, 1993

19. Thomasen E: Vertebral osteotomy for correction of kyphosis inankylosing spondylitis. Clin Orthop Relat Res194:142152,1985

20. van Royen BJ, Slot GH: Closing-wedge posterior osteotomy forankylosing spondylitis. Partial corporectomy and transpedicu-lar xation in 22 cases. J Bone Joint Surg Br77:117121, 1995

Manuscript submitted June 28, 2011.Accepted December 14, 2011.Please include this information when citing this paper: published

online January 20, 2012; DOI: 10.3171/2011.12.SPINE11568.Address correspondence to:Zhongqiang Chen, M.D., Orthopaedic

Department, Peking University 3rd Hospital, No 49. North GardenStreet, HaiDian District, Beijing, China 100191. email: [email protected].

TABLE 6: Complications observed in the surgical correction in 36 patients

Complication No.* Duration Treatment

CSF leakage 2 during surgery repair

nerve root injury 2 during surgery uid resuscitation, methylprednisolone, & neurotropic medicines

neurological decit 1 during surgery uid resuscitation, methylprednisolone, & neurotropic medicinespseudarthrosis 1 30 mos postop revision surgery

* A VCR had been performed in all cases.

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Clinical Evaluation of Sp Tb