Effectiveness of Kyphosis Reduction Using Cantilever Method in Thoracolumbar Spondylitis Tuberculosis: A Short-Term Follow-Up

Didik Librianto,1 Ismail Hadisoebroto Dilogo,2 Achmad Fauzi Kamal,2 Ifran Saleh,2 Fachrisal Ipang,1 Dina Aprilya2 1Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia; 2Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, IndonesiaCorrespondence: Dina AprilyaDepartment of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Prof. Soelarto building, 1st floor, RS Fatmawati Street, Jakarta, 12430, IndonesiaTel +6289655106136Fax +6221-7660616Email dina.cia.aprilya@gmail.comBackground: Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis.Methods: This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020– 2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients.Results: At the 3-months follow-up, the mean Cobb angle was 14.6°± 10.27°, with the mean gain of 20.90°± 12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°± 13.08°, 39.4°± 16.02°, and 1.4± 4.09 cm, respectively, with sagittal Cobb difference of 12.70± 9.85.Conclusion: The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.Keywords: thoracolumbar spine, kyphotic deformity, spondylitis tuberculosis, deformity correction, cantilever technique