scholarly journals Functional and Radiological Outcomes of Anterior Decompression and Posterior Stabilization via Posterior Transpedicular Approach in Thoracic and Thoracolumbar Pott's Disease: A Retrospective Study

2017 ◽  
Vol 11 (4) ◽  
pp. 618-626
Author(s):  
Suryakant Singh ◽  
Hitesh Dawar ◽  
Kalidutta Das ◽  
Bibhudendu Mohapatra ◽  
Somya Prasad
Keyword(s):  
Retrospective Study ◽  
Posterior Approach ◽  
Spinal Tuberculosis ◽  
Operation Time ◽  
Anterior Decompression ◽  
Posterior Stabilization ◽  
Bony Fusion ◽  
Transpedicular Approach ◽  
The Mean

<sec><title>Study Design</title><p>This is a retrospective study.</p></sec><sec><title>Purpose</title><p>To determine the efficacy and safety of a posterior transpedicular approach with regard to functional and radiological outcomes in people with thoracic and thoracolumbar spinal tuberculosis.</p></sec><sec><title>Overview of Literature</title><p>Spinal tuberculosis can cause serious morbidity, including permanent neurological deficits and severe deformities. Medical treatment or a combination of medical and surgical strategies can control the disease in most patients, thereby decreasing morbidity incidence. A debate always existed regarding whether to achieve both decompression and stabilization via a combined anterior and posterior approach or a single posterior approach exists.</p></sec><sec><title>Methods</title><p>The study was conducted at the Indian Spinal injuries Centre and included all patients with thoracic and thoracolumbar Pott's disease who were operated via a Posterior transpedicular approach. Data regarding 60 patients were analyzed with respect to the average operation time, preoperative and postoperative, 6 months and final follow-up American Spinal Injury Association (ASIA) grading, bony fusion, implant loosening, implant failure, preoperative, postoperative, 6 months and final follow-up kyphotic angles, a loss of kyphotic correction, Oswestry disability index (ODI) score, and visual analog scale (VAS) score. Data were analyzed using either a paired t -test or a Wilcoxon Signed Rank test.</p></sec><sec><title>Results</title><p>The mean operation time was 260±30 minutes. Fifty-five patients presented with evidence of successful bony fusion within a mean period of 6±1.5 months. Preoperative dorsal and lumbar angles were significantly larger than postoperative angles, which were smaller than final follow-up angles. The mean kyphotic correction achieved was 12.11±14.8, with a mean decrease of 5.97 and 19.1 in VAS and ODI scores, respectively.</p></sec><sec><title>Conclusions</title><p>Anterior decompression and posterior stabilization via a posterior transpedicular approach are safe and effective procedures, with less intraoperative surgical duration and significant improvements in clinical and functional status.</p></sec>

scholarly journals Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

2019 ◽  
Vol 10 (02) ◽  
pp. 225-233
Author(s):  
Mantu Jain ◽  
Rabi Narayan Sahu ◽  
Sudarsan Behera ◽  
Rajesh Rana ◽  
Sujit Kumar Tripathy ◽  
...  
Keyword(s):  
Visual Analog Scale ◽  
Vertebral Body ◽  
Posterior Approach ◽  
Spinal Tuberculosis ◽  
X Rays ◽  
Analog Scale ◽  
Bony Fusion ◽  
Universal Approach ◽  
The Mean

ABSTRACT Background: Surgical management of spinal tuberculosis (TB) has been classically the anterior, then combined, and of late increasingly by the posterior approach. The posterior approach has been successful in early disease. There has been a paradigm shift and inquisitive to explore this approach in the more advanced and even long-segment disease. Our study is a retrospective analysis by authors in variable disease pattern of TB Spine operated at an institute using a single posterior approach. Settings and Design: A retrospective case study series in a tertiary level hospital. Aims: The aim of this study is to evaluate the functional and radiological results of an all posterior instrumented approach used as a “universal approach” in tubercular spondylodiscitis of variable presentation. Materials and Methods: The study is from January 2015 to May 2018. Twenty-four of 38 patients met the inclusion criterion with a male: female = 8:16, and mean age 44.26 years. The initial diagnosis of TB was based on clinic-radiologic basis. Their level of affection, number of vertebrae affected, and vertebral body collapse, the kyphosis (preoperative, predicted, postoperative, and final residual) and bony fusion were measured in the preoperative, postoperative, and final X rays. Functional scoring regarding visual analog scale and Frankel neurology grading was done at presentation and follow-up of patients. Histopathological data of all patients were collected and anti-tubercular therapy completed for a period of 1 year with 4 drugs (HRZE) for 2 months and 2 drugs (HR) for rest of period. Statistical Analysis Used: The descriptive data were analyzed by descriptive statistics, and other parameters were calculated using the appropriate statistical tests such as the Student paired t-test for erythrocyte sedimentation rate, visual analog scale score, and kyphosis. Results: The mean number of vertebrae involved was 3.29 ± 0.86 (2–6) with mean vertebral body destruction was 0.616. Preoperatively, the mean kyphosis angle was 22.42° ± 12.56° and was corrected postoperatively to 13.08° ± 11.34° with an average correction of 9.34° (41.66%). At the latest follow-up, there was mean loss of correction of 0.80° resulting in 13.88° of final correction. Bony fusion was achieved in 20 patients (83.33%) cases. Neurological recovery occurred in all patients (100%), and 92% could be ambulatory at 1 year follow-up. There was improvement of visual analog scale from 6.33 ± 1.05 preoperatively to 1.042 ± 0.75 at 3 months of postoperative period. Two patients had bed sore, two had urinary infection, and one had neurological worsening requiring re exploration and cage removal eventually recovering to Frankel E. Two patients died due to unrelated cause. Conclusions: The procedure in safe and has satisfactory results in variable group affection of Pott’s spine including early and late disease, multisegment involvement using pedicle screw fixation with/without cage support.

scholarly journals Surgery for thoracolumbar junction (T12-L1) tuberculosis a multicentre, retrospective study

2019 ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Posterior Approach ◽  
Spinal Tuberculosis ◽  
Surgical Techniques ◽  
Operation Time ◽  
Thoracolumbar Junction ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Approach Group

Abstract Purpose A multicentre, retrospective study was conducted to evaluate the safety and efficacy of different surgical techniques for thoracolumbar junction (T12-L1) tuberculosis. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 257) from January 2005 to January 2015 were collected and reviewed. A total of 45 patients were operated on by an anterior approach (Group A), 52 by a combined anterior and posterior approach (Group B) and 160 by a posterior approach (Group C). Anti-tuberculosis therapy was performed both before and after surgery. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Results All three surgical approaches achieved bone fusion, pain relief and neurological recovery. The mean loss of correction in group A at last follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time and blood loss in group B were greater than in groups A and C. Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only approach is superior to the anterior-only approach in the correction of kyphosis and maintenance of spinal stability. The posterior-only approach is recommended because it achieves the same efficacy as the anterior-only or combined approach but with shorter operation times, less trauma and less blood loss. Keywords Spinal tuberculosis; Thoracolumbar junction; Three approaches.

scholarly journals Instrumentation in Potts Spine: A Two Year Retrospective Study in CCM Medical College and Hospital Durg

2018 ◽  
Vol 3 (08) ◽  
Author(s):  
Dr. Adarsh Trivedi
Keyword(s):  
Vertebral Body ◽  
Late Onset ◽  
Operation Time ◽  
Signs And Symptoms ◽  
Kyphotic Deformity ◽  
Mechanical Trauma ◽  
Palpable Mass ◽  
Bony Fusion ◽  
Transpedicular Approach

Most of the patient suffering from tuberculosis can be managed on anti-tuberculous therapy. Spinal TB patients can present with various signs and symptoms which include leg or back pain, palpable mass in the paraspinal region, kyphotic deformity and neurological compromise, out of these most important sequelae of TB spine are kyphotic deformity and neurological compromise. The spinal cord undergoes intrinsic changes due to tuberculosis and late-onset paraplegia is produced, with consequent poor chances of neural recovery even after surgery. When treatment is started the diseased segment of the spine or vertebral body is the weakest portion and it must be protected by suitable external braces. Fracture and dislocation of a diseased vertebral body may occur secondary to mechanical trauma and surgical decompression adds further instability. So indications for instrumented stabilisation can be advised. Surgical management or instrumentation in Pott’s spine helps regain motor function and ameliorates disability. Material and Methods: 38 patients were included with Thoracic and Thoracolumbar Pott's disease.  Included patients were having severe kyphosis with an active disease. Clinical evaluation of the outcome measures were evaluated at baseline, postoperatively and at 3rd, 6th and 1 year. Preoperative and postoperative X-ray, loss of kyphotic correction. Average operation time, bony fusion and implant failure were observed. Results: During study period total 1456 patients were diagnosed as TB out of which 99 were extra pulmonary cases and 58 were diagnosed as pott’s spine with thoracic and  thoracolumbar TB and 38 patients were included in the study who meet the inclusion criteria for our study. In our study of the 38 patients 18 were male and 20 were female patients. Mean age was 43.82. In Dorsal group D1 to D4, D5 to D8 and D9 to D12 involvement was seen in 4(10.53%), 10 (26.32%) and 13 (34.21%) respectively. Multi-segment involvement was observed in 3 (7.89%) patients. Dorsolumbar and lumbar involvement was seen in 5 patients. In lumber, L1 to L2, L2 to L3, L3 to L4 and L4 to L5 involvement was 1(2.63%), 0, 1(2.63%) and 2 (5.26%) respectively. Mean operation time was 290±41minutes and mean hospital stay was 16 days ranging from 8 days to 72 days. 34 patients had a successful bony fusion within a mean of 7±1.2 months, whereas 4 patients had late fusion or nonfusion because of secondary infections. Mean preoperative kyphosis was 21 degrees which was corrected to 9 degrees in final follow up after instrumentation. Conclusion: Instrumented stabilisation is safe in spinal TB. Posterior transpedicular approach is a safe surgical procedure for thoracic and thoracolumbar Pott's spine. Also Posterior transpedicular approach shows improved functional status and significantly improves neurological pain and fusion rate. However clinical trials with a larger sample size and a longer follow-up period are required.

scholarly journals THORACIC DISC HERNIATION: SURGICAL DECOMPRESSION BY POSTERIOR APPROACH A LA CARTE

2016 ◽  
Vol 15 (3) ◽  
pp. 213-218 ◽  
Author(s):  
MURILO TAVARES DAHER ◽  
PEDRO FELISBINO JUNIOR ◽  
ADRIANO PASSÁGLIA ESPERIDIÃO ◽  
BRENDA CRISTINA RIBEIRO ARAÚJO ◽  
ANDRÉ LUIZ PASSOS CARDOSO ◽  
...  
Keyword(s):  
Disc Herniation ◽  
Posterior Approach ◽  
Surgical Decompression ◽  
Thoracic Disc Herniation ◽  
Transpedicular Approach ◽  
Partial Body ◽  
The Mean ◽  
Thoracic Disc ◽  
A La Carte

ABSTRACT Objectives: To present the clinical and radiographic results of patients with thoracic disc herniation treated by the posterior approach, according to location and type of hernia (à la carte). Methods: We evaluated thirteen patients (14 hernias) treated by the posterior approach. Eight (61.5%) patients were male and the mean age was 53 years (34-81). Clinical evaluation was performed by the Frankel and JOA modified scales. All the patients underwent the posterior approach, which was performed by facetectomy, transpedicular approach, transpedicular + partial body resection, costotransversectomy or costotransversectomy + reconstruction with CAGE. Results: The mean follow-up was 2 years and 6 months (11-77 months). Of the 14 operated hernias, six (43%) were lateral, 2 (14%) paramedian, and 6 (43%) central. Seven were soft (50%) and seven were calcified. The transfacet approach was carried out in 5 cases (36%), transpedicular in 1 case (7%), transpedicular + partial body resection in 4 (29%), costotransversectomy in 3 (21%), and costotransversectomy + CAGE in one case (7%). The majority of patients with lateral hernia (5/6) were subjected to transfacet decompression and in cases of central and paramedian hernias, all patients underwent decompression, which is more extensive. Conclusions: The posterior approach is safe and effective, and the best approach must be chosen based on location and type of the herniation and the surgeon's experience.

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

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.

scholarly journals Surgical treatment of mono-segmental spinal tuberculosis using a combination of debridement and extreme lateral interbody fusion (XLIF): A retrospective study

2020 ◽  
Author(s):  
Yi Zhan ◽  
Ke Chen ◽  
Wuliang Huang ◽  
Weijian Chen ◽  
Yulin Lin
Keyword(s):  
Retrospective Study ◽  
Spinal Cord Injuries ◽  
Spinal Tuberculosis ◽  
Iliopsoas Muscle ◽  
Institutional Review ◽  
Extreme Lateral Interbody Fusion ◽  
Vertebral Bodies ◽  
The Mean ◽  
Lateral Interbody

Abstract Background This study investigated the clinical efficacy and safety of a combination of debridement and extreme lateral internal fusion (XLIF) for mono-segmental spinal tuberculosis (TB). Methods The medical records of 9 patients (aged 21–70 years; 6 males) with mono-segmental spinal TB treated at our hospital between January 2014 and November 2016 were retrospectively reviewed. The involved vertebral bodies included 2 cases each at the T6/7, L2/3 or L3/4 level and 1 case each at the T7/8, T8/9, or T9/10 level. Results All patients were successfully treated with a combination of debridement and XLIF. The mean length of the operation was 97.3 ± 20.6 min (range, 65–126 min), and the mean blood loss during surgery was 151.1 ± 25.7 ml (range, 105–185 ml). Two patients experienced sensory disturbance over the left thigh and iliopsoas muscle weakness after surgery. After a mean follow-up of 12.3 ± 3.7 months (range, 6–17 months), the mean Cobb angle decreased from 28.7 ± 6.7 degrees to 12.1 ± 3.7 degrees. The mean VAS pain score decreased from 7.2 ± 1.1 preoperatively to 2.3 ± 0.9 postoperatively. The mean bone graft fusion time was 5.6 months (range, 4.7–7.2 months). At the final follow-up, spinal cord injuries were evaluated as ASIA Grade D in 5 patients and ASIA Grade E in 4 patients. Conclusions A combination of debridement and XLIF is effective for the treatment of mono-segmental spinal TB, and is associated with minimal intraoperative trauma, few complications, and an improved quality of life for patients. Trial registration: This was a retrospective study. The study was approved by the institutional review board and the committee of our hospital. Informed consent to use their data was obtained from all patients before surgery.

scholarly journals A new surgical treatment for post-tubercular thoracic kyphosis, a retrospective study.

2020 ◽  
Author(s):  
Wenhao Hu ◽  
Huawei Liu ◽  
Fangqi Hu ◽  
Qi Wang ◽  
Teng Li ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vertebral Column ◽  
Thoracic Kyphosis ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Operation Time ◽  
Osteotomy Site ◽  
Bony Destruction ◽  
The Mean

Abstract Background: In the late stage of Spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations. Deformity more commonly occurs and rapidly progresses in the thoracic spine. The surgical treatment of deformity in the thoracic region poses a challenge to the spine surgeon because its high neurological risk. Vertebral column decancellation，a new spinal osteotomy technique, is thought to be suitable for most patients with severe rigid kyphosis. In the current study, we report VCD technique as another surgical strategy for correction of post-tubercular thoracic kyphosis and evaluate the clinical and radiographic patient results.Methods: Between January 2016 and January 2018, 16 patients with post-tubercular thoracic kyphosis underwent the Vertebral column decancellation. Preoperative and postoperative Konstam’s angle were measured. Oswestry Disability Index(ODI) ,Visual analog scale(VAS) and American Spinal Injury Association(ASIA) were documented. The mean follow-up was 31.4 months Results: The average operation time was 226 minutes (range, 200–260 minutes) with a mean intraoperative blood loss of 466 mL (range, 400–580 mL).The Konstam’s angles decreased from 88.8°(range, 76°–103°)preoperatively to 19.0°(range, 9°–32°)at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 7.0(range, 6–8) to 1.7 (range, 1–3, P<0.01) and the ODI improved from 67.6% (range, 59%–77%) to 20.7% (range, 15%–33%, P<0.01). At final follow-up, there was radiographic evidence of solid fusion at the osteotomy site and fixed segments in all patients. Neurological function improved from ASIA scale D to E in 6 patients, C to D in 3 patients.Conclusion: Our results suggest that VCD is a safe and effective treatment option for post-tubercular thoracic kyphosis. This technique achieves higher correction and fusion rates with adequate decompression of neurological elements.

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

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.

Single-Stage Transpedicular Approach for Circumferential Arthrodesis in Traumatic Lumbar Vertebral Body Burst Fractures

2019 ◽  
Vol 16 (01) ◽  
pp. 14-20 ◽  
Author(s):  
Mayank Garg ◽  
Amandeep Kumar ◽  
Pankaj Kumar Singh ◽  
Deepak Agrawal ◽  
Guru Dutt Satyarthee ◽  
...  
Keyword(s):  
Posterior Approach ◽  
Lumbar Region ◽  
Nerve Root Injury ◽  
Transpedicular Approach ◽  
Burst Fractures ◽  
Lumbar Vertebral Body ◽  
Cage Subsidence ◽  
Cobb’S Angle ◽  
The Mean

Abstract Background Traumatic vertebral burst fractures can be surgically approached via different approaches (anterior/posterior, or combined). Posterior transpedicular approach (PTA) is a posterior approach that has the advantage of achieving circumferential arthrodesis via single posterior-only approach. The purpose of this study was to analyze our experience with PTA in management of traumatic lumbar burst fractures (TLBFs). Methods All consecutive patients with TLBFs managed with PTA over 3 years’ duration were included in this retrospective study. Correction of kyphotic deformity and change in neurologic status were analyzed to assess outcome. Cobb’s angle and American Spinal Injury Association (ASIA) grade were used for this purpose. Results There were 12 males and 8 females. Five patients had complete (ASIA-A) while 12 had incomplete injury. The mean preoperative Cobb’s angle was 14.23 degrees that improved to–3.21 degrees postoperatively (mean kyphosis correction: 17.44 degrees). None of the patients developed iatrogenic nerve root injury. There was no perioperative mortality. The mean Cobb’s angle was 1.45 degrees at 36 months’ follow-up. Four patients developed cage subsidence but none required revision surgery. Postoperatively, 13 (65%) patients showed neurologic improvement and none deteriorated. The average ASIA score improved from 2.82 to 4.23. A fusion rate of 96% was observed at last follow-up. Conclusion The advantages of PTA including sense of familiarity with posterior approach among spine surgeons, lesser approach-related morbidity, and results comparable to anterior/combined approaches, make the PTA an attractive option for managing TLBFs. Although technically difficult, it can be successfully used for circumferential arthrodesis in the lumbar region without sacrificing nerve roots.

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

2019 ◽  
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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