Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis

Purpose To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. Methods Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. Results The average period of follow-up was 34.3 ± 9.5 months (24–56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. Conclusion Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.

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

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.

Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB)

Background Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes. Methods Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients. Results The patients were followed up for 20–48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120–280 min), whereas 818.0 ml of blood was lost (range, 400–1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = − 11.6, P<0.01). The preoperative kyphotic Cobb’s angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = − 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6–16 months). Conclusion Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.

Surgical Treatment Spine Tuberculosis by Decompression and Posterior Stabilization via Transpedicular Approach: a Retrospective Study

Clinical intervention has a central role in the outcome of spondylitis tuberculosis cases. Surgical procedures indicate to prevent neurological collapse, preservation of stability, and early mobilization. The study aims to analyze the outcome of surgical intervention in spinal tuberculosis by using a transpedicular approach. This research was a retrospective study on the Department of Orthopaedics and Traumatology in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, during 2016–2018. There were 64 subjects in this study; 35 were male, and 29 were female, ages ranged 21–60 years with a follow-up period of 12 months to 18 months. A more common site of tubercular lesion was at the thoracal lesion (44%). In this research, the patients were preoperatively categorized by the American Spinal Injury Association (ASIA) Impairment Assessment. Among them four were ASIA-A, 10 were ASIA-B, 30 were ASIA-C, 15 were ASIA-D, and five were ASIA-E. After the operative procedure, two patients were ASIA-B, five patients were ASIA-C, 17 patients were ASIA-D, and 40 were ASIA-E. Maximum patients (62%) had bony fusion grade 1. Greater than 80% of subjects had a satisfactory result. In conclusion, posterior decompression and preservation of stability with transpedicular fusion are an excellent surgical way of posterior lumbar spinal tuberculosis treatment. TINDAKAN OPERASI DEKOMPRESI DAN STABILISASI POSTERIOR MELALUI PENDEKATAN TRANSPEDIKULAR PADA TUBERKULOSIS TULANG BELAKANG: STUDI RETROSPEKTIFTindakan medis berperan penting pada manajemen akhir kasus tuberkulosis tulang belakang. Prosedur operasi dilakukan untuk mencegah perburukan defisit neurologis, menjaga kestabilan tulang belakang, dan mobilisasi dini. Tujuan penelitian ini adalah menganalisis luaran hasil tindakan operatif pada tuberkulosis tulang belakang dengan pendekatan transpedikular. Penelitian ini merupakan studi retrospektif pada Departemen Orthopaedi dan Traumatologi RSUP Dr. Hasan Sadikin, Bandung, Indonesia, periode tahun 2016–2018. Terdapat 64 subjek dalam penelitian ini yang terdiri atas 35 laki-laki dan 29 perempuan, serta usia berkisar 21–60 tahun dengan masa tindak lanjut 12–18 bulan. Pada penelitian ini, lesi tuberkuler paling banyak terjadi di regio torakal (44%). Subjek penelitian dikategorikan menurut Impairment Assessment dari American Spinal Injury Association (ASIA). Preoperatif terdapat empat pasien ASIA-A, 10 pasien ASIA-B, 30 pasien ASIA-C, 15 pasien ASIA-D, dan lima pasien ASIA-E. Setelah tindakan operasi terdapat dua pasien ASIA-B, lima pasien ASIA-C, 17 pasien ASIA-D, dan 40 pasien ASIA-E. Mayoritas pasien memiliki fusi tulang grade 1 (62%). Lebih dari 80% subjek penelitian menyatakan puas setelah operasi dilakukan. Simpulan, tindakan operatif dekompresi dan stabilisasi dengan fusi transpedikular merupakan metode yang unggul dalam manajemen tuberkulosis tulang belakang.

Postoperative outcome in thoracolumbar spinal tuberculosis: a retrospective study

Background: Spinal tuberculosis is the most common location of extra pulmonary tuberculosis. ATT alone may not be suitable in all situations, especially when treating patients with risk of instability, progression of neurologic deficit, and failure of medical treatment. Surgical intervention is a major treatment modality for symptom relief in spinal tuberculosis.Methods: The aim of this study was to assess the immediate post-operative outcome in surgically treated patients with dorsolumbar spine tuberculosis at Department of Neurosurgery Government Medical College, Thrissur. All operated patients of dorsolumbar spinal tuberculosis during 2014 September to 2019 august were included under study.Results: A total of 57 patients were included in the study. The mean age of the patient was 42.77 years. There were 40 males (70.2%) and 17 females (29.8%). 55 (96.5%) out of 57 patients were having sensory symptoms. 41 (71.9%) out of 57 patients were having motor symptoms. Bladder involvement 23 (40.4%) and bowel involvement 15 (26.3%) were also noted in the study. Sensory symptoms improvement in post-operative period was noted in 46 (80.7%). Motor symptoms improvement was observed in 23 (56.1%) out of 41. Bladder symptoms improved in 6 (26.1%) out of 23. There is improvement in clinical symptoms, neurological function immediately after surgery. Surgical patients have faster improvement and can be mobilized earlier. Improvement in sensory symptoms (96.5%), motor symptoms (56.1%) and bladder symptoms (26.1%) were noted in our study in the immediate post-operative period.Conclusions: There was significant immediate relief in symptoms and morbidity of patients undergoing surgical treatment for dorsolumbar spine tuberculosis.

Bone and joint tuberculosis in patients undergoing dialysis: clinical features, risk factors, and outcomes in 17 patients

Objective This study was performed to investigate the clinical features, risk factors, and outcomes of bone and joint tuberculosis in patients undergoing dialysis. Methods We systematically reviewed the medical records of 17 patients with bone and joint tuberculosis undergoing dialysis who were admitted to our hospital from January 2009 to January 2019. Results Seventeen patients with bone and joint tuberculosis undergoing dialysis were identified in this retrospective study, and 13 patients were undergoing hemodialysis. The mean age of the 17 patients was 61.3 years (range, 32–82 years), and 10 (58.9%) patients were male. Most of the patients had a low CD4+ cell count and low hemoglobin and albumin levels. Surgery was performed in 6 patients (35.3%), and 13 of the 17 patients (76.4%) were cured. Three patients had bone or spine sequelae, mainly because of a delayed diagnosis, and one patient died of heart failure. Conclusion These findings indicate that older age, a low CD4+ cell count, and low hemoglobin and albumin levels are possible risk factors for bone and spine tuberculosis in patients undergoing dialysis. If diagnosed early, most patients should have a good outcome after anti-tubercular therapy with or without surgery.

Retroperitoneoscopic drainage of cryptogenic psoas abscess

Psoas abscess is a rare and occasionally life-threatening condition. In the past, the major cause of psoas abscess was a descending infection originating from spine tuberculosis (Pott’s disease). Subsequently, secondary infection from spondylodiscitis or Crohn’s disease has become the prevalent aetiology. Conventional treatment ranges from antibiotic therapy alone to CT-guided and/or surgical drainage. We present the case of a 67-year-old man with a complex history, including pneumonia, sepsis and previous muscle-skeletal trauma. The patient subsequently developed a psoas abscess that was successfully treated with a minimally invasive retroperitoneoscopic approach and antibiotics. Blood cultures and pus yielded Gram-positive Streptococcus sp, and transesophageal echocardiography identified endocarditis as a possible source of sepsis. Postoperative clinical course was complicated by recurrent sepsis that required a change of antibiotic therapy. The patient was eventually discharged to rehabilitation care without further complications. The retroperitoneoscopic approach is safe and effective for the treatment of cryptogenic psoas abscess.