Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

Abstract Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

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Radiological and clinical outcome of conservative management of thoracolumbar spinal tuberculosis in adults

International Journal of Orthopaedics Sciences ◽

10.22271/ortho.2020.v6.i1f.1885 ◽

2020 ◽

Vol 6 (1) ◽

pp. 335-342

Author(s):

Dr. Priyank Sahoo ◽

Dr. AN Mishra ◽

Dr. Vikas Trivedi ◽

Dr. Sharib Shamim ◽

Dr. Afroz Ahmed Khan ◽

...

Keyword(s):

Clinical Outcome ◽

Conservative Management ◽

Spinal Tuberculosis ◽

Thoracolumbar Spinal Tuberculosis

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LATERAL CAVITATORY APPROACH WITH CIRCUMSPINAL DECOMPRESSION IN TUBERCULOUS SPONDYLITIS: A 5YR FOLLOW-UP STUDY

10.36106/ijsr/1 ◽

2019 ◽

pp. 1-3

Keyword(s):

Spinal Fusion ◽

Pedicle Screw ◽

Spinal Tuberculosis ◽

Thoracolumbar Spine ◽

Spinal Instrumentation ◽

Posterior Spinal Fusion ◽

Neurological Complications ◽

Single Stage ◽

Laboratory Findings

Introduction: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antituberculous drugs to radical surgical extirpation. Opinion is divided on management of Potts Paraplegia with respect to surgical approach to the lesion. Results are conflicting on anterior verses posterior approaches as well combined approach. There is also confusion on to when to do anterior first or to operate from posterior first, in combined approaches. In the present study we present 10 year follow-up of our results, clinical and radiological outcomes, of Single stage Circumspinal decompression and pedicle screw fixation through lateral extracavitatory approach with anterior and posterior spinal fusion in cases of Pott's paraplegia. Methods:The study was a retrospective and prospective follow up of 30 patients with active tuberculosis of thoracolumbar spine with neurological deficit, who underwent posterior spinal instrumentation with lateral extra cavitatory approach with circumspinal decompression and pedicle screw instrumentation. Diagnosis of spinal tuberculosis was made by laboratory findings such as anaemia, elevated ESR, radiological features with typical MR imaging findings. 8 patients had multilevel involvement. Kyphosis of 250 to 550 was present. Circumspinal decompression, correction of kyphosis, anterior and posterior spinal fusion was performed in a single stage. The average follow up was 7.67 years (92 months). Results: The mean kyphosis angle improved from 320 preoperatively to 80 in early follow up, followed by a minor loss of correction of 30. Neurological recovery occurred in 28 patients out of 30 patients. 15 patients recovered from Asia A to AIS E. 13 patients recovered to ASIA D. The visual analog scale and ASIA grade improved in all the cases. Implant failure in the form of rod breakage was seen in 1 patient but with no neurological complications. Conclusion: Drainage of abscess, debridement by extracavitatory route constitutes a less demanding, relatively safe, minimally traumatic operative technique with adequate circumspinal decompression of spinal cord, correction and maintenance of sagittal balance with relatively less morbidity is the added advantage.

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Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults

British Journal of Neurosurgery ◽

10.1080/02688697.2016.1206182 ◽

2016 ◽

Vol 30 (6) ◽

pp. 666-671 ◽

Cited By ~ 13

Author(s):

Penghui Zhang ◽

Wei Peng ◽

Xiyang Wang ◽

Chengke Luo ◽

Zhengquan Xu ◽

...

Keyword(s):

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Single Stage ◽

Thoracolumbar Spinal Tuberculosis

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Single-stage posterior-only debridement, decompression and interbody fusion for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses

BMC Surgery ◽

10.1186/s12893-021-01092-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Wence Wu ◽

Zhechen Li ◽

Renqin Lin ◽

Shenglin Wang ◽

Jianhua Lin

Keyword(s):

Blood Loss ◽

Cobb Angle ◽

Interbody Fusion ◽

Spinal Tuberculosis ◽

Operating Time ◽

Single Stage ◽

Allograft Bone ◽

Titanium Mesh ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background To explore the clinical safety and efficacy of single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion combined for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses. Methods A total of 38 patients diagnosed with thoracolumbar spinal tuberculosis complicated with psoas abscesses underwent surgery via single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion from January 2010 to September 2016 were enrolled in the study. The clinical efficacy of the approach was assessed based on parameters including operating time, blood loss, Cobb angle, visual analogue scale (VAS) scores, Frankel grade, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results The surgery duration was 224.4 ± 71.1 min with a blood loss of 731.8 ± 585.8 ml. The Cobb angle was corrected from 16.0 ± 15.4° preoperatively to 8.1 ± 7.4° postoperatively (P < 0.001, t = − 4.38), and returned to a level of 11.0 ± 8.5° at the final follow-up (P = 0.002, t = 3.38). Back pain was relieved, with the mean preoperative VAS of 3.5 ± 1.1 decreased to 0.7 ± 0.8 postoperatively (P < 0.001, t = 23.21) and then to 0.6 ± 0.5 at the final follow-up (P < 0.001, t = 17.07). Neurological function was improved in various degrees and psoas abscesses disappeared in all patients. The ESR and CRP decreased gradually after surgery and returned to normal at the final follow-up in all patients. All patients achieved bone fusion thoroughly and no recurrence of TB or surgical related complications was found at the final follow-up. Conclusion Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion is a safe and effective approach for the management of thoracolumbar spinal tuberculosis complicated with psoas abscesses.

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A comparative study of single-stage transpedicular debridement, fusion, and posterior long-segment versus short-segment fixation for the treatment of thoracolumbar spinal tuberculosis in adults: minimum five year follow-up outcomes

International Orthopaedics ◽

10.1007/s00264-018-3807-0 ◽

2018 ◽

Vol 42 (8) ◽

pp. 1883-1890 ◽

Cited By ~ 6

Author(s):

Zheng Liu ◽

Penghui Zhang ◽

Hao Zeng ◽

Zhengquan Xu ◽

Xiyang Wang

Keyword(s):

Comparative Study ◽

Spinal Tuberculosis ◽

Single Stage ◽

Short Segment ◽

Segment Versus ◽

Short Segment Fixation ◽

Thoracolumbar Spinal Tuberculosis

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Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses

10.21203/rs.3.rs-107029/v1 ◽

2020 ◽

Author(s):

Wence Wu ◽

Zhechen Li ◽

Renqin Lin ◽

Shenglin Wang ◽

Jianhua Lin

Keyword(s):

Blood Loss ◽

Cobb Angle ◽

Interbody Fusion ◽

Spinal Tuberculosis ◽

Operating Time ◽

Single Stage ◽

Allograft Bone ◽

Titanium Mesh ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background: To explore the clinical safety and efficacy of single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion combined for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses.Methods: A total of 38 patients diagnosed with thoracolumbar spinal tuberculosis complicated with psoas abscesses underwent surgery via single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion from January 2010 to September 2016 were enrolled in the study. The clinical efficacy of the approach was assessed based on parameters including operating time, blood loss, Cobb angle, visual analogue scale (VAS) scores, Frankel grade, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Results: The surgery duration was 224.4 ± 71.1 min with a blood loss of 731.8 ± 585.8 ml. The Cobb angle was corrected from 16.0 ± 15.4° preoperatively to 8.1 ± 7.4° postoperatively (P < 0.001, t = -4.38), and returned to a level of 11.0 ± 8.5° at the final follow-up (P = 0.002, t = 3.38). Back pain was relieved, with the mean preoperative VAS of 3.5 ± 1.1 decreased to 0.7 ± 0.8 postoperatively (P < 0.001, t = 23.21) and then to 0.6 ± 0.5 at the final follow-up (P < 0.001, t = 17.07). Neurological function was improved in various degrees and psoas abscesses disappeared in all patients. The ESR and CRP decreased gradually after surgery and returned to normal at the final follow-up in all patients. All patients achieved bone fusion thoroughly and no recurrence of TB or surgical related complications was found at the final follow-up. Conclusion: Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion is a safe and effective approach for the management of thoracolumbar spinal tuberculosis complicated with psoas abscesses.

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The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

10.21203/rs.2.14957/v3 ◽

2020 ◽

Author(s):

Bingjin Wang ◽

Wenbin Hua ◽

Wencan Ke ◽

Yukun Zhang ◽

Xianlin Zeng ◽

...

Keyword(s):

Surgical Treatment ◽

Spinal Injury ◽

Spinal Tuberculosis ◽

Allograft Bone ◽

Titanium Mesh ◽

Analog Scale ◽

Bony Fusion ◽

The Mean ◽

Thoracolumbar Spinal Tuberculosis

Abstract Background: The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.Methods: We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.Results: All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up.Conclusions: Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

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