STUDY DESIGN: A review of related literatures of diagnosis and treatment of spinal tuberculosis. OBJECTIVES: The aim of the study was to discuss treatment strategies by understanding of emerging problems related to spinal tuberculosis. SUMMARY OF LITERATURE REVIEW: Owing to modern diagnostic modalities, development of prevention and chemotherapy, the incidences of tuberculosis infection including spinal tuberculosishave been decreasing. Moreover, these medical these improvements of medical and surgical treatments the improvement of surgical techniques for spinal tuberculosis reduced the incidence of kyphosis or neurologic complications such as Pott's paralysis. MATERIALS AND METHODS: Review of related literatures. RESULTS: Recently,the occurrence of multi-drug resistant strain, an increasing number of opportunistic infections and an atypical presentation in spinal tuberculosis are emerging as new challenges. CONCLUSIONS: An appropriate diagnosis and surgical interventions are our obligation as clinicians dealing with this unique infectious disease to minimize the complications for the treatment of spinal tuberculosis.
Communicable Diseases ; Diagnosis ; Drug Therapy ; Incidence ; Kyphosis ; Opportunistic Infections ; Paralysis ; Spine* ; Tuberculosis* ; Tuberculosis, Spinal

PURPOSE: To assess the chronological changes of disease-related kyphosis after chemotherapy alone. MATERIALS AND METHODS: A total of 101 children aged 2 to 15 years with spinal tuberculosis, accompanied by various stages of disease processes were enrolled for analysis. By utilizing the images in them, the growth plate condition and chronological changes of kyphosis after chemotherapy were analyzed at two points in time; the first assessment was at post-chemotherapy one-year and second at the final discharge. RESULTS: Complete disc destruction in the cervical, dorsal and lumbosacral spines was observed in 2 out of 40 children (5.0%), 8 out of 30 children (26.7%), and 6 out of 31 children (19.4%), respectively. In those cases, the residual kyphosis inevitably developed. In the remaining children, the discs were intact or partially damaged. Among the 101 children kyphotic deformity was maintained without change in 20 children (19.8%). Kyphosis decreased in 14 children (13.9%), while it increased in 67 children (66.3%) with non-recoverably damaged growth plate. CONCLUSION: Although it is tentatively possible to predict the deformity progress or non-progress and spontaneous correction at the time of the initial treatment, its predictive accuracy is low. Therefore, assessment of the chronological changes should be performed at the end of chemotherapy. In children with progressive curve change, assessment of deformity should be continued until maturity.
Child* ; Congenital Abnormalities* ; Drug Therapy ; Growth Plate ; Humans ; Kyphosis ; Spine ; Tuberculosis* ; Tuberculosis, Spinal*

Since researches and clinical experiences up to now provide us with little helps in predicting what type of spinal tuberculosis will result in good healing by chemotherapy alone without kyphosis or with minimum kyphosis, it seems impractical to await natural healing with unsightly kyphosis. Therefore, my opinion is that surgery to achieve early cure and to correct and/or prevent kyphosis is desirable. The two-stage operation
Child ; Drug Therapy ; Follow-Up Studies ; Humans ; Immobilization ; Kyphosis ; Parents ; Spine ; Transplants ; Tuberculosis ; Tuberculosis, Spinal

BACKGROUND: Finding an optimal treatment strategy for adolescent idiopathic scoliosis (AIS) patients remains challenging because of its intrinsic complexity. For mild to moderate scoliosis patients with lower skeletal growth potential (Risser 3-5), most clinicians agree with observation treatment; however, the curve progression that occurs during puberty, the adolescent period, and even in adulthood, remains a challenging issue for clinicians. The aim of the study is to investigate the efficacy of Schroth exercise in AIS patients with lower skeletal growth potential (Risser 3-5) and moderate scoliosis (Cobb angle 20°-40°). METHODS: From 2015 to 2017, data of 64 patients diagnosed with AIS in Peking University Third Hospital were reviewed. Forty-three patients underwent Schroth exercise were classified as Schroth group, and 21 patients underwent observation were classified as observation group. Outcomes were measured by health-related quality of life (HRQOL) and radiographic parameters. HRQOL was assessed using the visual analog scale (VAS) scores for back, Scoliosis Research Society-22 (SRS-22) patient questionnaire. Radiographic spinopelvic parameters were obtained from anteroposterior and lateral X-rays. The pre-treatment and post-treatment HRQOL and radiographic parameters were tested to validate Schroth exercise efficacy. The inter-rater reliability of the radiographic parameters was tested using the interclass correlation coefficient (ICC). The paired t test was used to examine HRQOL and radiographic parameters. Clinical relevance between C2-C7 sagittal vertical axis (SVA) and thoracic kyphosis was analyzed using Spearman correlation. RESULTS: In Schroth group, VAS back score, SRS-22 pain, and SRS-22 self-image domain were significantly improved from pre-treatment 3.0 ± 0.8, 3.6 ± 0.5, and 3.5 ± 0.7 to post-treatment 1.6 ± 0.6 (t = 5.578, P = 0.013), 4.0 ± 0.3 (t = -3.918, P = 0.001), and 3.7 ± 0.4 (t = -6.468, P < 0.001), respectively. No significant improvements of SRS-22 function domain (t = -2.825, P = 0.088) and mental health domain (t = -3.174, P = 0.061) were observed. The mean Cobb angle decreased from 28.9 ± 5.5° to 26.3 ± 5.2° at the final follow-up, despite no statistical significance was observed (t = 1.853, P = 0.102). The mean C2-C7 SVA value decreased from 21.7 ± 8.4 mm to 17.0 ± 8.0 mm (t = -1.224 P = 0.049) and mean T1 tilt decreased from 4.9 ± 4.2 ° to 3.5 ± 3.1° (t = 2.913, P = 0.011). No significant improvement of radiographic parameters and HRQOL were observed in observation group. CONCLUSIONS For AIS patients with a Risser 3-5 and a Cobb angle 20°-40°, Schroth exercises improved HRQOL and halted curve progression during the follow-up period. Both cervical spine alignment and shoulder balance were also significantly improved after Schroth exercises. We recommend Schroth exercises for patients with AIS.
Adolescent ; Adult ; Cervical Vertebrae ; Humans ; Kyphosis ; Lordosis ; Quality of Life ; Reproducibility of Results ; Retrospective Studies ; Scoliosis/therapy* ; Treatment Outcome

Tuberculosis of the spine is still prevalent in many parts of the world and still remains as an important orthopaedic problem in Korea. Moreover, spinal tuberculosis is the most common and dangerous form of skeletal tuberculosis. With the availability of very effective antituberculous drugs two divergent controversy in the management of tuberculosis of the spine have been reported. A large group of surgeons has advocated the radical excision of the tuberculous focus and replacement of the defect with autogenous bone grafts under cover of chemo-therapy, and another practise is typified by regimen of Friedman, Konstam, Kaplan, and Stevenson and Manning, who treated a large number of patients with spinal tuberculosis using antiuberculous drugs alone. Even now, because of the shortage of hospital beds and ancillary help, private poor economy and patients general condition, some group of patient with tuberclous spine have been treated conservatively using effective antituberculous drugs. In this study authors clinically analysed the 75 patients who had conservative treatment with triple drug therapy for 18 months at the department of Orthopaedics, Catholic Medical College and Center during the past 10 years, and the results were as follows: 1. There were two prevalent age groups. One is the first decade (30.6%) and the other is the third decade(30.7%). The age prevalence in children was 6 to 10 years of age. 2. The lesions were common in the lumbar spine(56.0%) and the most commonly involved vertebra was L3. The average initial number of involved vertebral body was 1.9 vertebrae and it was changed to 2.3 vertebrae at the end of treatment(18 months). 3. Active pulmonary foci was associated in 17.4%(6.7% of tuberculous pleurisy included). 4. Out of 75 cases twenty-six(34.7%) had new involvement at the adjacent vertebra within 18 months after treatment. 5. The radiographic activity was assessed as active in all cases initially, but at 18 months after treatment 83% of the cases were in quiescent condition, and this percentage was increased to 78.7% at 36 months. 6. Spontaneous fusion rate of involved vertebral bodies was 24% at 18 months and 36% at 36 months after treatment, respectively. 7. Radiologically observed deep seated abscess shadow disappeared slowly over 3 to 20 months, but this disappearance was observed mainly within 8 months after treatment. 8. Mean increment of the kyphosis was average 7.5 degree (9.3° in children and 6.6° in adults) at the end of the treatment(18 months), and average 8.6 degree(10.9° in children and 7.3° in adults) at 36 months, by. internal gibbus angle. 9. Almost in all the adult patients, kyphosis developed during the active phase of the disease, while in children kyphosis progressed even after the healing of the disease. Children who had multiple vertebral involvement at the dorsal area had a tendency to develop more severe kyphosis. 10. Decrement of the kyphosis angle which located at the lumbar area after the end of the treatment was considered to be an effect of narmal lordotic curvature. 11. Generally representation of the changes seen in children was almost osteolytic change without sequestrum in comparison to adults who had more sequestrum formation. 12. In 95% of cases a favourable results were obtained.
Abscess ; Adult ; Child ; Drug Therapy ; Humans ; Korea ; Kyphosis ; Prevalence ; Spine ; Surgeons ; Transplants ; Tuberculosis ; Tuberculosis, Pleural ; Tuberculosis, Spinal

STUDY DESIGN: Randomized controlled single-blinded clinical trial. PURPOSE: To evaluate the efficacy of Schroth therapy on thoracic curve angle, pain, and self-perceived body image (SPBI) of the back in Scheuermann's patients in comparison with the efficacy of classic anti-gravitation exercises. OVERVIEW OF LITERATURE: Scheuermann disease is the most common cause of hyperkyphosis of the thoracic and thoracolumbar spine during adolescence. However, very few studies evaluated the effect of exercises on the progression of kyphosis in Scheuermann patients. Schroth three-dimensional exercise therapy was found in several studies to be effective in the treatment of adolescent scoliosis; however, we found no randomized controlled trials that evaluated the efficacy of this method in Scheuermann patients. METHODS: A total of 50 young adults (males and females) with Scheuermann's disease were randomly divided into either the experimental group (Schroth therapy treatment, n=25) or the control group (classic anti-gravitation exercises, n=25). Participants in both the groups were provided a course of individual treatment sessions during few weeks, with one appointment per week. They were required to perform the exercises daily throughout the study period (12 months) and fill their performance in a research log. We evaluated the thoracic Cobb angle (main outcome measure), pain, SPBI, flexion of the shoulder (supine), flexion of the shoulder (standing), kyphotic deformity measured using inclinometer, and L5 kyphosis apex line (L5-KAL) as well as administered the Scoliosis Research Society-22 Questionnaire for the participants before the treatment, after 6 months, and 1 year postoperatively. These results were then compared. RESULTS: In the mixed analysis of variance, the main effect of time was significant in the thoracic kyphosis (F [1]=5.72, p=0.02), and in the L5-KAL (F [1]=5.76, p=0.02). The main effect of time on the kyphotic deformity, measured using an inclinometer, did not reach the significance level; however, it showed the tendency (F [1]=2.80, p=0.07). In the group-by-time interaction, a significant difference was found in the thoracic kyphosis (F [1]=4.91, p=0.03) and in the kyphotic deformity, measured using an inclinometer (F [1]=4.05, p=0.02). Thus, the Schroth therapy group showed significantly greater improvement than the classic anti-gravitation exercises group. CONCLUSIONS: The present findings indicate that back exercises in general, and Schroth therapy in particular, is an effective treatment for preventing and significantly improving the thoracic Cobb angle and symptomatic representation in Scheuermann's patients.
Adolescent ; Body Image ; Congenital Abnormalities ; Exercise ; Exercise Therapy ; Humans ; Kyphosis ; Methods ; Physical Therapy Modalities ; Posture ; Quality of Life ; Randomized Controlled Trials as Topic ; Scheuermann Disease ; Scoliosis ; Shoulder ; Spine ; Young Adult

STUDY DESIGN: A retrospective study OBJECTIVE: To analyze the safety and effectiveness of treatments using metallic implants in the tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Residual kyphosis and loss of correction remain the major problems following surgery for tuberculous spondylitis. Several authors have used metallic implants for the prevention of these complications. However, the safety of metallic implants use in tuberculous spine infections are still controversial. MATERIALS AND METHODS: Seventeen patients, who underwent surgery, and were stabilized by the use of a metallic implant for tuberculous spondylitis, and followed up for more than 1 year were included in this study. All patients were treated with combined anterior fusion (with or without mesh) and/or posterior pedicle screw instrumentation. The patients were followed up with serial plain radiographs, laboratory inflammatory parameters and neurological recovery. RESULTS: The overall correction of the kyphotic deformity was initially 8.5 degrees, and loss of correction occurred at 5.8 degrees. Although some loss of correction occurred, even after the use of a metallic implant, clinically significant kyphotic deformity was effectively prevented. There were no cases of persistent infection or failure to control infection when the metallic implantation was combined with an anterior radical debridement and chemotherapy. The erythrocyte sedimentation rate and C-reactive protein were eventually normalized in all patients. The preoperative neurological deficits were: incomplete paralysis in 9 cases and radiculopathy in 4. At the final follow-up, 11 cases had completely recovered, partial residual neurological deficits remaining in 2. CONCLUSIONS: The use of instrumentation with metallic implants, in tubercuous spondylitis of the spine, provided immediate stability, and did not prohibit the control of infection when combined with radical debridement and anti-tuberculous chemotherapy.
Blood Sedimentation ; C-Reactive Protein ; Congenital Abnormalities ; Debridement ; Drug Therapy ; Follow-Up Studies ; Humans ; Kyphosis ; Paralysis ; Radiculopathy ; Retrospective Studies ; Spine ; Spondylitis*

OBJECTIVETo explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.

METHODSThe clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients, among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs, lab tests, MRI findings, pathology findings, and clinical effects were analyzed.

RESULTSAll four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano, 3 cases obtained excellent results, while 1 poor.

CONCLUSIONSThe incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments, thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate, C-reactive protein level, MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.

Back Pain ; Fracture Fixation, Internal ; Humans ; Kyphosis ; Lumbar Vertebrae ; Lumbosacral Region ; Retrospective Studies ; Spinal Fusion ; Surgical Wound Infection ; drug therapy ; epidemiology ; Treatment Outcome

Few studies have been conducted to explain the pain patterns resulting from osteoporotic vertebral compression fractures (OVCF). We analyzed pain patterns to elucidate the pain mechanism and to provide initial guide for the management of OVCFs. Sixty-four patients underwent percutaneous vertebroplasty (N=55) or kyphoplasty (N=9). Three pain patterns were formulized to classify pains due to OVCFs: midline paravertebral (Type A), diffuse paravertebral (Type B), and remote lumbosacral pains (Type C). The degree of compression was measured using scale of deformity index, kyphosis rate, and kyphosis angle. Numerical rating scores were serially measured to determine the postoperative outcomes. As vertebral body height (VBH) decreased, paravertebral pain became more enlarged and extended anteriorly (p<0.05). Type A and B patterns significantly showed the reverse relationship with deformity index (p<0.05), yet Type C pattern was not affected by deformity index. Postoperative pain severity was significantly improved (p<0.05), and patients with a limited pain distribution showed a more favorable outcome (p<0.05). The improvement was closely related with the restoration of VBH, but not with kyphosis rate or angle. Thus, pain pattern study is useful not only as a guide in decision making for the management of patients with OVCF, but also in predicting the treatment outcome.
Aged ; Aged, 80 and over ; Female ; Fracture Fixation, Internal/methods ; Fractures, Compression/etiology/radiography/*surgery ; Humans ; Kyphosis/therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoporosis/*complications/diagnosis ; Pain/etiology/*surgery ; Pain Measurement ; Pain, Postoperative/etiology ; Polymethyl Methacrylate/administration & dosage/therapeutic use ; Questionnaires ; Sickness Impact Profile ; Spinal Fractures/radiography/*surgery ; Tomography, X-Ray Computed ; Treatment Outcome