KYPHOSIS SECONDARY TO TUBERCULOSIS OSTEOMYELITIS AS A CAUSE OF VENTILATORY FAILURE - CLINICAL-FEATURES, MECHANISMS, AND MANAGEMENT

Study objectives: To investigate the relationship of thoracic kyphosis following tuberculosis to the development of ventilatory failure and to assess the efficacy of nocturnal noninvasive ventilatory support. D esign: Retrospective consecutive case series with crossover from a pha se without noninvasive ventilatory support to a phase with this treatm ent. Setting: The Respiratory Support and Sleep Centre, Papworth, Hosp ital, Cambridge, England. Patients: Seven patients with thoracic kypho sis following tuberculous osteomyelitis which had been contracted by t he age of 4 years were studied. Their mean age was 53 (SD 7.1) years a nd the mean angle of kyphosis was 113.60. All patients were in ventila tory failure. Interventions: The patients were treated with nocturnal noninvasive ventilation with either an individually constructed cuiras s shell and a negative pressure pump or nasal intermittent positive pr essure ventilation using a volume preset ventilator. Measurement and r esults: Each patient underwent an initial clinical assessment along wi th radiologic studies of the spine, pulmonary function tests, daytime arterial blood gas tensions, and overnight recordings of arterial satu ration, and transcutaneous carbon dioxide tension. They were reassesse d in detail at a mean of 5 years after starting ventilatory support, S ymptoms, vital capacity, daytime carbon dioxide tension, and overnight oximetry had all improved following treatment. Temporary withdrawal o f ventilatory support led to severe sleep fragmentation in four patien ts and the appearance of central apneas and hypopneas in the other thr ee, Six of the 7 patients were alive at a mean of 5.7 years after star ting nocturnal ventilation. Conclusion: These results show that ventil atory failure may develop, after an interval of many years, in patient s with a severe thoracic kyphosis due to tuberculosis in childhood. No ninvasive nocturnal ventilatory support can control the symptoms of ve ntilatory failure, improve the physiologic abnormalities, and is assoc iated with prolonged survival.