Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly

Zhao, Jie; Lian, Xiao; Hou, Tie Sheng; Ma, Hui; Chen, Zhi Ming

doi:10.1007/s00264-006-0253-1

Cited by 34 publications

(24 citation statements)

References 12 publications

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“…However, the majority of surgeons favour the anterior approach because of concern over the safety of the posterior approach [8,9]. The anterior surgical approach includes an anterolateral extrapleural approach and a transpleural anterior approach, which was developed by Hodgson et al [1,14] and has been used by many surgeons for spinal tuberculous lesions [2,[15][16][17]. The anterior approach is considered to be very important because it can provide the surgeon with direct access to the diseased vertebral segments to perform radical surgical debridement of the infected tissues.…”

Section: Discussionmentioning

confidence: 99%

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

Zhou

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to compare posterior and anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. These approaches were compared in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis. Methods Forty-seven patients with thoracic and lumbar tuberculosis who underwent either the posterior or the anterior approach in combination with debridement, interbody autografting and instrumentation from January 2004 to March 2010 were reviewed retrospectively. In group A (n=25), the posterior approach was combined with debridement, interbody autografting and instrumentation. In group B (n=22), the anterior approach was performed in addition to debridement, interbody autografting and instrumentation. Results All cases were followed up for 12-62 months. There was no statistically significant difference between groups in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis (p>0.05). Good clinical outcomes were achieved in both groups. ConclusionsThe posterior approach combined with debridement, interbody autografting and instrumentation is an alternative procedure to treat thoracic and lumbar tuberculosis. The posterior approach is sufficient for lesion debridement. In addition, the posterior approach can maintain spinal stabilisation and prevent loss of corrected vertebral alignment as effectively as the anterior approach.

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Section: Discussionmentioning

confidence: 99%

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

Zhou

et al. 2011

International Orthopaedics (SICOT)

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“…In the report of Jin et al [2], a mean of 18°of kyphosis correction was achieved in adult patients after anterior instrumentation surgery during the follow-up period. Zhao et al [27] found kyphotic deformity was corrected by an average of about 16°using anterior instrumentation and fusion, and in the follow-up period, correction loss was 1°(6.3%). According to Karaeminogullari et al [6], the mean correction loss at final follow-up (mean five years) following anterior radical debridement and fusion or posterolateral debridement, fusion and instrumentation alone was 45-50%, whereas the corresponding finding for anterior radical debridement and fusion plus posterior instrumentation and fusion was 12%.…”

Section: Discussionmentioning

confidence: 98%

Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults

Zheng

Cui

et al. 2011

International Orthopaedics (SICOT)

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Purpose There are few articles in the literature comparing outcomes between anterior and posterior instrumentation in the management of thoracic and lumbar spinal tuberculosis (TB). Methods Between January 2004 and December 2009, 217 adult patients, average age 39 (range 16-67) years with thoracic and lumbar spinal TB were treated by anterior radical debridement and fusion plus instrumentation, anterior radical debridement with fusion and posterior fusion with instrumentation, posterolateral debridement and fusion plus posterior instrumentation or transpedicular debridement and posterior fusion with instrumentation in a single-or two-stage procedure. We followed up 165 patients for 22-72 (mean 37) months. Of these, 138 underwent more than three weeks chemotherapy with isoniazid, rifampin, pyrazinamide and ethambutol, and the remaining 27 underwent operation for neurological impairment within six to 18 hours of the same chemotherapy regimen. In no case did relapse occur. Apart from eight patients with skip lesions treated by hybrid anterior and posterior instrumentation, anterior instrumentation was used in 74 patients (group A) and 83 patients (group B) were fixed posteriorly. Results In both groups, local symptoms were relieved significantly one to three weeks postoperatively; ten of 14 patients (71%) in group A and 14 of 19 (74%) in group B with neurological deficit had excellent or good clinical results (P>0.05). Erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.7 mm/h, respectively, preoperatively to normal levels eight to 12 weeks postoperatively. Kyphosis degree was corrected by a mean of 11.5°in group A and 12.6°in group B, respectively (P< 0.01). Correction loss was 6.8°in group A and 6.1°in group B at the last follow-up (P<0.01). Fusion rates of the grafting bone were 92.5% and 91.8%, respectively, at final follow-up (P>0.05). Severe complications did not occur. Conclusion These results suggest that both anterior and posterior instrumentation attain good results for correction of the deformity and maintaining correction, foci clearance, spinal-cord decompression and pain relief in the treatment of thoracic and lumbar spinal TB providing that the opeartive indication is accurately identified. However, the posterior approach may be superior to anterior instrumentation to correct deformity and maintain that correction.

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“…Various surgical approaches were adopted to reduce lower lumbar spinal TB [4,5,14]. Majority of TB lesions involve the anterior and middle column; therefore, anterior debridement and bone grafting were recommended by some surgeons [15,16]. Nevertheless, the long term effect of the anterior approach showed that the bone graft was susceptible to collapse or absorption, and kyphosis was more severe [17,18].…”

Section: Clinical Datamentioning

confidence: 99%

Comparison of Three Interbody Fusion Methods Through Posterior Approach for Lower Lumbar Spinal Tuberculosis in Adults: a Study of Mid-Long Term Follow-Up

Xu¹,

Wang²,

Liu³

2020

Preprint

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Background: This study was conducted to compare mid-long term outcomes of three interbody fusion methods by way of posterior approach in adults with lower lumbar spinal tuberculosis.Methods: A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Of the three types of interbody bone grafts, 41 patients (group A) were treated with autogenous bone graft for interbody fusion , 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. Clinical and radiographic data were gathered and analyzed. Results: At the final follow-up, all patients were found to be completely cured. Neurological performance and quality of life were remarkably improved compared with those preoperative at the final follow-up. The preoperative lordosis angles of the three groups were significantly corrected compared with postoperative immediately values or those evaluated at the final follow-up. The correction loss of the group C was lower than those of groups A and B. All the patients obtained bone graft fusion; the fusion period of group B was longer than that of the other two groups. No significant differences among the three groups in adjacent segment degeneration rate were found at the last visit. Conclusions: This mid-long term follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation can effectively treat lower lumbar spinal tuberculosis. Moreover, intervertebral titanium mesh cage bone graft may provide better outcomes than autogenous or allogeneic bone graft. Background Spinal tuberculosis (TB), the most common extrapulmonary TB, accounts for about 50% of bone and joint TB [1]. This severe spinal disease often causes spinal instability, kyphosis, spinal nerve dysfunction, or even paraplegia [2]. Lower lumbar spine (L3-L5) is known to be the stress focus and an influencing site of TB. It has the characteristics of refractory, high disability, and recurrence rate, which seriously influences the quality of patients' life. Anti-TB drugs are used across the entire treatment period; a reasonable surgical treatment improves the cure rate [3].

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Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly

Cited by 34 publications

References 12 publications

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults

Comparison of Three Interbody Fusion Methods Through Posterior Approach for Lower Lumbar Spinal Tuberculosis in Adults: a Study of Mid-Long Term Follow-Up

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