Direct Internal Kyphectomy for Severe Angular Tuberculous Kyphosis
| Autor: | Yat-Wa Wong, John C. Y. Leong, Keith D. K. Luk |
|---|---|
| Rok vydání: | 2007 |
| Předmět: |
Adult
Male Thorax medicine.medical_specialty Decompression medicine.medical_treatment Kyphosis Intercostal nerves Blunt dissection medicine Humans Orthopedics and Sports Medicine Spinal canal Retrospective Studies Rib cage business.industry General Medicine Anatomy Middle Aged Decompression Surgical medicine.disease Surgery Spinal Fusion Treatment Outcome medicine.anatomical_structure Spinal fusion Female Tuberculosis Spinal Tomography X-Ray Computed business |
| Zdroj: | Clinical Orthopaedics & Related Research. 460:124-129 |
| ISSN: | 0009-921X |
| DOI: | 10.1097/blo.0b013e31805470db |
| Popis: | We describe a direct internal kyphectomy through a modified costotransversectomy, an extrapleural approach to the kyphus that does not jeopardize already compromised pulmonary function. A curved longitudinal incision is made 6 to 8 cm lateral to the midline. The posterior 5 cm of the two to three crowded ribs at the apex are resected. The segmental intercostal nerves are preserved as a guide into the spinal canal. Two to three pedicles at the apex are resected. The pleura are elevated with blunt dissection leading to the internal kyphus. Removal of the posterior half of the collapsed vertebrae is performed with a high-speed burr; the posterior walls are removed last to avoid forward migration of the dural sac as the decompression progresses. Cortical strut grafting is then performed as far anteriorly as the exposure permits. We treated five patients with paraparesis of healed disease with this approach. Preoperatively the mean kyphosis was 114 degrees. Neurological improvement was obtained in two patients. At a mean followup of 5 years, solid anterior fusion was achieved in four patients. One patient died 5 months after surgery because of chest infection. |
| Databáze: | OpenAIRE |
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