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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2019; 38(03): 219-226
DOI: 10.1055/s-0039-1693723
Case Report | Relato de Caso
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Four-rod Technique Stabilization after Pedicle Subtraction Osteotomy (PSO) for the Treatment of Thoracolumbar Hyperkyphosis Secondary to Pott Disease: A Two-Year Follow-Up Case Report

Técnica das quatro hastes após osteotomia de subtração pedicular para o tratamento de hipercifose toracolombar secundária à doença de Pott: Relato de caso de dois anos de seguimento
Alecio Cristino Evangelista Santos Barcelos
1   Division of Surgery, Hospital Universitário Lauro Wanderley, João Pessoa, PB, Brazil
3   Division of Neurosurgery, Hospital Estadual de Emergência e Trauma Senador Humberto Lucena, João Pessoa, PB, Brazil
,
Sterphany Ohana Soares Azevedo Pinto
2   Faculdade de Medicina, Universidade Federal da Paraíba, João Pessoa, PB, Brazil
,
Thaise Ellen de Moura Agra Teixeira
3   Division of Neurosurgery, Hospital Estadual de Emergência e Trauma Senador Humberto Lucena, João Pessoa, PB, Brazil
,
Rayana Ellen Fernandes Nicolau
4   Faculdade de Medicina Nova Esperança, João Pessoa, PB, Brazil
› Author Affiliations Funding The authors received no financial support for the research, authorship, and/or publication of the present article.
Further Information

Publication History

03 April 2019

12 June 2019

Publication Date:
02 August 2019 (online)

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Abstract

Pedicle subtraction osteotomy (PSO) is a powerful tool for the management of sagittal misalignment. However, this procedure has a high rate of implant failure, particularly rod breakages. The four-rod technique diminishes this complication in the lumbar spine. The aim of the present study is to provide a case report regarding PSO and four-rod technique stabilization in the treatment of short-angle hyperkyphosis in the thoracolumbar (TL) junction. The authors describe the case of a patient with TL hyperkyphosis secondary to spinal tuberculosis treated with L1 PSO and fixation with a four-rod technique. There were no major surgical complications. The self-reported quality of life questionnaires (the Short-Form Health Survey 36 [SF-36] and the Oswestry disability index) and radiological parameters were assessed preoperatively, as well as 6, 12 and 24 months after surgery, and they showed considerable and sustained improvements in pain control and quality of life. No hardware failure was observed at the two-year follow-up.

Resumo

A osteotomia de subtração pedicular (OSP) é uma ferramenta importante no manejo de doenças com desalinhamento sagital. Entretanto, este procedimento apresenta altas taxas de falência do instrumental, em especial a quebra de hastes. A técnica de fixação com quatro hastes reduz essa complicação na região lombar. O objetivo deste estudo é relatar um caso de hipercifose na transição toracolombar (TL) tratado com OSP e estabilização com a técnica das quatro hastes. Os autores descrevem o caso de uma paciente com hipercifose TL secundária a tuberculose espinhal, tradada com PSO e fixação com a técnica das quatro hastes. Não houve complicações cirúrgicas maiores. Os questionários autorrelatados de qualidade de vida (Short-Form Health Survey 36 [SF-36] e índice de incapacidade de Oswestry) e os parâmetros radiográficos foram avaliados no pré-operatório e 6, 12 e 24 meses após a cirurgia, e demonstram considerável e estável melhora na qualidade de vida e no controle da dor da paciente. Não houve falência da instrumentação após 2 anos de seguimento.

Keywords

pedicle subtraction osteotomy - kyphosis - spinal tuberculosis - four-rod technique - postoperative complications - thoracolumbar spine

Palavras-chave

osteotomia de subtração pedicular - cifose - tuberculose da coluna vertebral - técnica das quatro hastes - complicações pós-operatórias - coluna toracolombar

Ethical approval and consent to participate

The medical ethics committee of the Medical Sciences Center at Universidade Federal da Paraíba approved this study under the following registration number: CAAE 89898718.3.0000.8069. Before and during the present study, informed consent was obtained from the participant after a brief discussion and explanation.


Consent for publication

Written informed consent was obtained from the patient for the publication of this case report and its accompanying images.


Availability of data and materials

The data and materials used during the present study are available from the corresponding author on reasonable request.


Competing interests

The authors report no competing interests concerning the materials or methods used in the present study or the findings specified in this paper.


Author contribution

AB was in charge of patient management. He also wrote the case summary, and was responsible for supervising, correcting and proof-reading the writings of other authors. SP was involved in writing the manuscript alongside AB, as well as in maintaining patient follow-up. TT was involved in patient management; she supervised and proof-read the writings of other authors as well. RN participated in the writings of the discussion session. All authors read and approved the final manuscript.