{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:54:50Z","timestamp":1770962090708,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004829","name":"Science and Technology Department of Sichuan Province","doi-asserted-by":"publisher","award":["2021YFG0240"],"award-info":[{"award-number":["2021YFG0240"]}],"id":[{"id":"10.13039\/501100004829","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82072386"],"award-info":[{"award-number":["82072386"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Orthopaedic Surgery"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>Cervical tuberculosis (CTB) readily causes local kyphosis, and its surgical strategy remains controversial. Although some previous studies suggested that the anterior approach could effectively treat CTB, patients in these studies only suffered mild to moderate kyphosis. Therefore, little is known about whether the anterior approach can achieve satisfactory outcomes in CTB patients with severe kyphosis. This study was performed to evaluate the safety and efficacy of preoperative skull traction combined with anterior surgery for the treatment of CTB patients with a severe kyphosis angle of more than 35\u00b0.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this retrospective study, we enrolled 31 CTB patients with severe kyphosis who underwent preoperative skull traction combined with anterior surgery from April 2015 to January 2021. Patients were followed up for at least 2\u2009years. Clinical data, such as operative time, blood loss, and postoperative hospital stay, were collected. The clinical outcomes included American Spinal Injury Association (ASIA) spinal cord injury grade, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and related complications. The radiological outcomes included the Cobb angle of cervical kyphosis at each time point and the bony fusion state. Clinical efficacy was evaluated by paired Student's <jats:italic>t<\/jats:italic>\u2010test, Mann\u2013Whitney <jats:italic>U<\/jats:italic>\u2010test, and others.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six patients had involvement of one vertebra, 21 had involvement of two vertebrae, and four had involvement of three vertebrae. The most common level of vertebral involvement was C4\u20105, whereas the most common apical vertebra of kyphosis was C4. The mean kyphosis angle was 46.1\u00b0\u2009\u00b1\u20097.7\u00b0 preoperatively, and the flexibility on dynamic extension\u2010flexion X\u2010rays and cervical MRI was 17.5%\u2009\u00b1\u20097.8% and 43.6%\u2009\u00b1\u200911.0%, respectively (<jats:italic>p<\/jats:italic>\u2009=\u20090.000). The kyphosis angle significantly decreased to 13.2\u00b0\u2009\u00b1\u20093.2\u00b0 after skull traction, and it further corrected to \u22126.1\u00b0\u2009\u00b1\u20094.3\u00b0 after surgery, which was well maintained at the final follow\u2010up with a mean Cobb angle of \u22125.4\u00b0\u2009\u00b1\u20093.9\u00b0. The VAS and JOA scores showed significant improvement after surgery. The erythrocyte sedimentation rate (ESR) and C\u2010reactive protein (CRP) levels normalized at 3\u2009months after surgery. All patients achieved solid bone fusion, and no complications related to the instrumentation or recurrence were observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Preoperative skull traction combined with anterior debridement, autologous iliac bone grafting, and internal plate fixation can be an effective and safe surgical method for the treatment of cervical tuberculosis with severe kyphosis. Skull traction can improve the safety and success rate of subsequent anterior corrective surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/os.13830","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T11:01:18Z","timestamp":1690887678000},"page":"2549-2556","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preoperative Skull Traction, Anterior Debridement, Bone Grafting, and Internal Fixation for Cervical Tuberculosis with Severe Kyphosis"],"prefix":"10.1111","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3279-9262","authenticated-orcid":false,"given":"Zhuang","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ce","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li\u2010min","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tao","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7925-3323","authenticated-orcid":false,"given":"Xi","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2377-0740","authenticated-orcid":false,"given":"Yue\u2010ming","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital Sichuan University  Chengdu 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