The Journal of Bone and Joint Surgery, Vol 71, Issue 9 1314-1323, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis
S Rajasekaran and S Soundarapandian
Department of Orthopaedics, Madras Medical College, India.
The case of eighty-one patients who had tuberculosis of the spine that was
treated by debridement and anterior arthrodesis were reviewed eight years
or more postoperatively. We studied the progression of the kyphosis and
evaluated the function and fate of the bone grafts that were used. At eight
years, the results with respect to the progression of the kyphosis were
classified as excellent or good in forty-eight patients (59 per cent), all
of whom had had minimum destruction of the vertebral bodies; limited
surgical excision of bone, resulting in a small post-debridement defect
that needed only a short graft; marked intraoperative correction of the
deformity; and involvement of lower lumbar segments. Fifteen patients (19
per cent) had a fair result and eighteen (22 per cent), a poor result. An
increase in the deformity was common in patients who had extensive
involvement of the vertebral bodies that had resulted in a large
post-debridement defect necessitating a graft spanning more than two disc
spaces. Lesions of the thoracic vertebrae were associated with many of the
poor results, and patients who had a marked kyphosis before treatment also
did not do well. A stable graft that provided structural support was
observed in only thirty-three patients (41 per cent), and failure of the
graft due to slippage, fracture, absorption, or subsidence was seen in
forty-eight patients (59 per cent). The length of the graft also played a
role: the graft failed most often in patients in whom it spanned more than
two disc spaces. We concluded that it is unwise to rely solely on the graft
to prevent vertebral collapse in patients in whom the length of the graft
exceeds two disc spaces. These patients may benefit from additional
measures, such as an extended period of non-weight-bearing, posterior
arthrodesis after six to twelve weeks, and prolonged use of a brace until
complete consolidation is evident.
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