Abstract
The salient features are given of 35 patients with severe non-tuberculous kyphosis who later developed paraplegia.
No correlation could be found between the degree of kyphosis and the neurological impairment. In other words, many patients with similar or more severe deformities do not develop paraplegia.
Symptoms may develop rapidly even though the deformity has not become worse—suggesting that ischaemia is an important factor.
In many patients with kyphosis there is an associated anomaly of the spinal cord, and, understandably, such cords seem to be more vulnerable to pressure.
The aim of treatment is to preserve and improve the blood supply of the spinal cord. In ten patients the response to conservative treatment was good, though a relapse may occur later, in one patient many years later. In some of these patients a spinal stabilising operation was later performed, but it is not possible to compare the remote prognosis in these patients with those treated conservatively—e.g. by spinal braces. In 11 patients who did not respond to conservative treatment the results of laminectomy were good if an easily removable compressing agent was found, e.g. an extradural band or, stenosis of the dura, but there was no improvement in patients who already had gross changes in the cord.
In this series the results of removing the anterior bony ridge by anterolateral decompression were mostly poor (though there was one success), contrasting with the excellent results obtained by this method in Pott's paraplegia in the active phase (Roaf, Kirkaldy-Willis & Cathro, 1959). Paraplegia may be inevitable where there is an associated anomaly of the spinal cord.
In general, paraplegia associated with non-tuberculous kyphosis presents a different problem from Pott's paraplegia.
It is impossible that prevention of the kyphosis in infancy might avoid this distressing complication.
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References
Roaf, R, Kirkaldy-Willis & Cathro (1959). Surgical treatment of Bone and Joint Tuberculosis. Edinburgh: Livingstone.
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Roaf, R. Spinal deformity and paraplegia. Spinal Cord 2, 112–119 (1964). https://doi.org/10.1038/sc.1964.20
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DOI: https://doi.org/10.1038/sc.1964.20
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