Multidrug-resistant tuberculosis of lumbosacral spine producing extensive destruction with lumbosacral kyphosis

It is uncommon to get lumbosacral junction deformity due to tuberculosis. Lumbosacral junction alignment is of paramount importance in maintaining global sagittal balance. In this case report, we present a case of a 42-year-old woman with multidrug-resistant tuberculosis of lumbosacral spine with complete destruction of L3, L4 and L5 vertebra with partial destruction of L2 and S1 vertebra leading to significant shortening and lumbosacral kyphosis. The patient had severe axial low back pain, inability to sleep in supine position due to deformity and difficulty in walking due to loss of spinal alignment. The patient was treated with 6 weeks of antituberculous drugs followed by all posterior decompression with instrumentation from D10 to S2 with a reconstruction of anterior vertebral bodies with the help of an expandable cage. Antituberculous treatment was continued for 18 months. At present, the patient is asymptomatic with no neurological deficit and has completed 3.5 years of regular follow-up.

Progressive restoration of spinal sagittal balance after surgical correction of lumbosacral spondylolisthesis before skeletal maturity

OBJECT Spinopelvic alignment is crucial in assessing an energy-efficient posture in both normal and disease states, such as high-displacement developmental spondylolisthesis (HDDS). The overall effect in patients with HDDS who have undergone local surgical correction of lumbosacral imbalance for the global correction of spinal balance remains unclear. This paper reports the progressive spontaneous improvement of global sagittal balance following surgical correction of lumbosacral imbalance in patients with HDDS. METHODS The records of 15 patients with HDDS who underwent surgery between 2005 and 2010 were reviewed. The treatment consisted of L4–sacrum reduction and fusion via a posterior approach, resulting in complete correction of lumbosacral kyphosis. Preoperative, 6-month postoperative, and final follow-up postoperative angular measurements were taken from full-spine lateral radiographs obtained with the patient in a standard standing position. Radiographic measurements included pelvic incidence, sacral slope, lumbar lordosis, and thoracic kyphosis. The degree of lumbosacral kyphosis was evaluated by the lumbosacral angle. Because of the small number of patients, nonparametric tests were considered for data analysis. RESULTS Preoperative lumbosacral kyphosis and L-5 anterior slip were corrected by instrumentation. Transient neurological complications were noted in 5 patients. Statistical analysis showed a significant increase of thoracic kyphosis on 6-month postoperative and final follow-up radiographs (p < 0.001). A statistically significant decrease of lumbar lordosis was noted between preoperative and 6-month control radiographs (p < 0.001) and between preoperative and final follow-up radiographs (p < 0.001). CONCLUSIONS Based on the authors' observations, this technique resulted in an effective reduction of L-5 anterior slip and significant reduction of lumbosacral kyphosis (from 69.8° to 105.13°). Due to complete reduction of lumbosacral kyphosis and anterior trunk displacement associated with L-5 anterior slipping, lumbar lordosis progressively decreased and thoracic kyphosis progressively increased postoperatively. Adjusting the sagittal trunk balance produced not only pelvic anteversion, but also reciprocal adjustment of lumbar lordosis and thoracic kyphosis, creating a satisfactory level of compensated global sagittal balance.