Surgical treatment of tuberculosis of spine: Nepalese experience

Introduction : Spinal tuberculosis treatment goal is eradication of the disease, neurological protection, and deformity prevention. Accepted indications for conservative or surgical management of the disease are still lacking. The purpose of this study was to classify disease based on pre- and post-treatment clinical and radiological criteria to help management. Material and methods : Out of 101 patients, retrospectively reviewed between 2007 and 2015, seventy adult patients (44 males, mean age 29 years, range 16-76) were included in the study. Patients were evaluated clinically for pain, deformity and neurological status while radiological evaluation included sagittal deformity, vertebra destruction and number of vertebrae involvement. 60 patients underwent surgery (abscess drainage, 2; anterior radical debridement and fusion, 12; anterior debridement + posterior instrumentation, 26; posterior instrumentation, 20) All patients were given anti-tuberculous treatment for 12 months. Mean follow up period was 44.9 months (range: 6-108 months). Result: Pre-treatment pain (Visual analogue score, VAS 0-10, mean 7.52) improved by 0.99 at last follow up. Number of vertebrae involved ranged from 1 to 15 (mean 4.2). 38 patients had obvious clinical deformity with Cobb angle mean 36.6° (range 10°-130°). Deformity was corrected at mean of 17.5° (range: -60° to 90°) at last follow up. There were two ASIA A, eight ASIA B, five ASIA C, four ASIA D and 51 patients with ASIA E neurology at the time of presentation. One patient with ASIA A neurology remained same even after decompression while other patient died on the day of surgery. Out of 8 patients with ASIA B neurology six patients improved to ASIA E, one patient remained same and one patient deteriorated to ASIA A. In ASIA C group, three patients improved to ASIA E. One patient deteriorated to ASIA A. All four patients with ASIA D neurological status improved to ASIA E. And all 51 patients with pre-operative ASIA E status remained same but one deteriorated to ASIA C. Eight patients had deformity progression, two patients had deep vein thrombosis, two patients had superficial wound infection and one patients had recurrent cold abscess. Two patients died due to associated co-morbidities. Based upon the clinical and radiological pre- and post-operative findings; Uncomplicated spines were managed conservatively or with abscess drainage (USG or CT – guided). Complicated spines were managed with posterior instrumentation and complex spines were managed with anterior / posterior procedure (posterior only approach) Conclusion: Based upon the outcome of treatment of spinal tuberculosis, conservative treatment results in healing of the disease process with residual deformity while surgical treatment in selected cases results in early pain alleviation, spinal balance, neurologic protection and eventually early return to work.

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Surgical treatment of preschool childhood spinal thoracic tuberculosis: two case reports and technical note

Romanian Neurosurgery ◽

10.2478/romneu-2018-0010 ◽

2018 ◽

Vol 32 (1) ◽

pp. 85-93

Author(s):

Mehmet Nuri Erdem ◽

Anas Abdallah ◽

Sinan Karaca ◽

Mehmet Aydoğan

Keyword(s):

Surgical Treatment ◽

Case Reports ◽

Pediatric Population ◽

Posterior Instrumentation ◽

Spinal Tuberculosis ◽

Technical Note ◽

Neurological Deficits ◽

Pott’S Disease ◽

Surgical Options

AbstractBackground: The development of paraplegia and kyphosis are two important problems related to spinal tuberculosis (Pott’s disease) in children. The current study aims to present two pediatric Pott’s disease, point out the progression of this disease in children, surgical options and surgical outcomes.Materials and methods: Two cases of childhood Pott’s disease were referred to our department with progressive neurological deficits (both of children were experienced bilateral weakness in lower extremities; grade C according to Frankel scale) during short periods (less than one month per each). Both cases’ MRIs are demonstrated abscesses in thoracic spine. Both patients are treated surgically. We discussed in this study the technical notes in both cases, especially in 2- year-old child.Results: Both cases were treated surgically after decompressing nerve roots and thecal sac posterior instrumentation was applied. Microbiological examination of both samples revealed on M.Tuberculosis. Orthoses are applied three months after operations. Antituberculosis medication protocol was applied. Preoperative paraparesis had recovered completely and muscle strengths all returned to normal in both children. There is no loss of correction during the follow-up periods.Conclusion: Spinal tuberculosis is a dynamic disease that may lead to severe deformities in childhood. Especially in cases where two or more vertebrae are affected, early surgical treatment is essential to prevent severe kyphosis. Surgical intervention accompanied with antituberculosis medications protocol is essential to cure treatment in pediatric population. In children aged ≤6 years and more than one vertebrae were affected, fıbula can be used to allow growth of the child vertebral column.

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Can We Extrapolate SINS Score to Evaluate Instability in Spinal Tuberculosis?

Global Spine Journal ◽

10.1177/21925682211030876 ◽

2021 ◽

pp. 219256822110308

Author(s):

Yogesh Kishorkant Pithwa ◽

Vikrant Sinha Roy

Keyword(s):

Prospective Observational Study ◽

Surgical Intervention ◽

Spinal Tuberculosis ◽

Neurological Status ◽

Structural Instability ◽

Stable Group ◽

Surgical Decision ◽

Helpful Tool ◽

Surgical Decision Making

Study Design: Prospective Observational Study. Objectives: To assess the feasibility of utilizing SINS score, originally suggested for neoplastic conditions, to assess structural instability in spinal tuberculosis. Methods: Patients with an established diagnosis of spinal tuberculosis were included in the study. Based on SINS scoring, patients classified as those with “indeterminate stability” were managed with or without surgery based on other parameters including neurological status, severity of pain, medical comorbidities, etc. Results: Eighty [39 males, 41 females] patients prospectively evaluated with mean age 46.74 ± 17.3 years. Classification done into stable [n = 7], indeterminate [n = 45] and unstable [n = 28] groups based on SINS scoring. All the patients in unstable group were treated with surgical stabilization whereas none in the stable group required surgical stabilization. In the indeterminate group, 26 patients underwent surgical stabilization, while 19 treated non-operatively. Major determinants predisposing to surgical intervention in “indeterminate group” were pain [14 of 26 patients] and neurological status [11 of 26 patients]. Mean follow-up 38.5 ± 22.61 months with minimum follow-up being 24 months. Preoperative VAS score for pain improved from median of 9/10 to 1/10 following surgery [ P < .0001]. In the non-operative group, the improvement was from median score of 6/10 to 1/10 [ P < .0001]. Preoperative ODI improved in non-operative and operative group from median of 42% and 70%, respectively to 10% and 12%, respectively in the postoperative period [ P < .0001 for both groups]. Conclusions: SINS scoring can be a helpful tool in surgical decision-making even in spinal tuberculosis. Further refinement of the score can be done with a larger, multicenter study.

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NONCOMPLICATED UNSTABLE SPINE INJURIES IN CHILDREN

Hirurgiâ pozvonočnika ◽

10.14531/ss2005.2.8-12 ◽

2005 ◽

pp. 008-012 ◽

Cited By ~ 1

Author(s):

Eduard Vladimirovich Ulrikh ◽

Sergey Valentinivich Vissarionov ◽

Aleksandr Yuryevich Mushkin

Keyword(s):

Surgical Treatment ◽

Posterior Instrumentation ◽

Spinal Injuries ◽

Anterior Decompression ◽

Two Stage ◽

Spinal Stabilization ◽

Spine Injuries ◽

Group A ◽

Bone Autograft

Thirty-four patients aged from 3 to 17 years were operated on for noncomplicated unstable injuries of the spine. The operation was performed within the next few hours or days after trauma in 15 cases and significantly later (in 2 to 6 months) in 19 cases. In the first group the surgery included indirect posterior instrumental reduction and stabilization of the spine. In the second group a two-stage surgery was performed simultaneously. The first stage included anterior decompression and stabilization, and the second – posterior instrumentation. In both groups the posterior fusion with bone autograft was done. The post-op follow-up was 5 years. The correction of deformity, spinal stabilization and pain arrest were achieved in all cases. The surgical treatment of unstable noncomplicated spinal injuries in children must be conducted by emergency indications within the first hours and days after trauma.

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Efficacy Analysis of One-stage Posterior-only Surgical Treatment for Thoracic Spinal Tuberculosis in the T4-6 Segments with Minimum 5-year Follow-up

10.21203/rs.3.rs-769455/v1 ◽

2021 ◽

Author(s):

Yi Zhan ◽

Xin Kang ◽

Wenjie Gao ◽

Xinliang Zhang ◽

Lingbo Kong ◽

...

Keyword(s):

Surgical Treatment ◽

Cobb Angle ◽

Clinical Efficacy ◽

Spinal Tuberculosis ◽

Surgical Trauma ◽

Posterior Surgery ◽

One Stage ◽

Thoracic Spinal ◽

Thoracic Spinal Tuberculosis

Abstract In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4-6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments. 67 patients with tuberculosis in T4-6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4-6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

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Continuous Incremental Heavy Halo Traction Combined with Posterior-only Approach for Severe Cervical Kyphosis with Neurofibromatosis-1.

10.21203/rs.2.15877/v1 ◽

2019 ◽

Author(s):

Chaofeng Guo ◽

Hongqi Zhang ◽

Zhenhai Zhou ◽

Jinyang Liu ◽

Ang Deng

Keyword(s):

Posterior Instrumentation ◽

Neurological Status ◽

Neurofibromatosis 1 ◽

Neurological Deficits ◽

Cervical Kyphosis ◽

Kyphosis Correction ◽

Halo Traction ◽

Key Words Neurofibromatosis ◽

Correction Result

Abstract Background Surgical management of cervical kyphosis in patients with NF-1 is a challenging task. Presently, anterior-only (AO), posterior-only (PO) and combined anterior-posterior (AP) spinal fusion are common surgical strategies. However, the choice of surgical strategy and application of Halo traction remain controversial. Few studies have shown and recommended posterior-only approach for cervical kyphosis correction in patients with NF-1. The aim of this study is to evaluate the safety and the effectiveness of Continuous-Incremental-Heavy Halo Traction (CIH-HT) combined with posterior-only approach for treatment of cervical kyphosis with NF-1. Methods 19 patients with severe cervical kyphosis due to NF-1 were reviewed retrospectively between January 2010 and April 2017. All the cases underwent CIH-HT combined with posterior instrumentation and fusion surgery. Correction result, neurologic status and complications were analyzed. Results In this study, cervical kyphosis Cobb angle decreased from initial 63.0 ± 21.0 degrees to postoperative 10.8 ± 4.0 degrees(P＜0.01),with total correction rate of 92%, which consist of 44% from CIH-HT and 48% from surgical correction. JOA scores were improved from preoperative 13.6±1.6 to postoperative 16.0±1.0(P＜0.01). Neurological status was also improved. There was no correction loss and the neurological status was stable in mean 3.7 years follow-up. The incidence of complications was 36.8% (7/19). Six patients underwent local complications and one patient underwent a second surgery. Conclusion CIH-HT combined PO approach is safe and effective method for cervical kyphosis correction in patients with NF-1. A satisfied correction result, and successful bone fusion can be achieved via this procedure, even improvement of neurological deficits can also be obtained. Our study suggested that CIH-HT combined PO approach is another consideration for cervical kyphosis correction in patients with NF-1. Key words : Neurofibromatosis-1; Cervical kyphosis; Continuous-Incremental-Heavy Halo Traction; posterior-only approach;

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Structural Manubrium Autograft in Cervical Fusion for Patients With Cervical Tuberculosis: A Preliminary Study

10.21203/rs.3.rs-116921/v1 ◽

2020 ◽

Author(s):

Shuang Xu ◽

QING WANG ◽

YI LING XIONG ◽

GAOJU WANG ◽

JIN YANG ◽

...

Keyword(s):

Cervical Spine ◽

Posterior Instrumentation ◽

Donor Site ◽

Spinal Tuberculosis ◽

Visual Analog Scale Score ◽

Cervical Fusion ◽

Radiographic Findings ◽

Neurological Outcomes ◽

Spine Tuberculosis

Abstract Background The purpose of this study was to evaluate the efficacy and safety of structural manubrium autografts in the surgical treatment of cervical spinal tuberculosis.Methods From January 2015 and December 2018, 10 patients with lower cervical spine tuberculosis (C4-C7) underwent anterior debridement, interbody fusion with structural manubrium autograft, and anterior or posterior instrumentation. The medical records and radiographic findings of the patients were reviewed.Results The surgery duration was 198.5 min and blood loss was 355.0 mL. The average preoperative kyphosis angle was 16.3 ± 8.2° and returned to -2.1 ± 2.8° two weeks postoperatively (P < 0.05 ), reaching -1.4 ± 2.5° at final follow-up (P < 0.05 vs. preoperative). The average preoperative visual analog scale score of neck pain was 4.1 ± 1.1, which decreased to 1.5 ± 0.8 one week after the surgery (P < 0.05 ) and to 0.7 ± 0.5 at final follow-up. The ESR and CRP gradually decreased postoperatively, becoming normal at final follow-up. Bony fusion was achieved in all patients by 6 months after surgery. Neurological outcomes were improved by 1–2 grades in most patients. There were no postoperative complications associated with the donor site, and there was no recurrence of tuberculosis in any patient.Conclusion Structural bone obtained from the manubrium is safe, providing a viable alternative to cervical fusion for patients with cervical spine tuberculosis. It confers the advantages of autograft fusion without the complications associated with donor site morbidities.

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