Anterior Spinal Instrumentation in Treatment of Spinal Tuberculosis

Kim, Ki Soo; Ko, Seung Hee; Youm, Kyung Sung; Choi, Chul Hun; Yang, Jin Ho

doi:10.4055/jkoa.1998.33.6.1560

Cited by 16 publications

(5 citation statements)

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“…Lee et al [ 16 ] reported that the correction of the kyphotic angle and loss of correction were statistically significant (p < 0.05) in both the anterior instrumentation and fusion groups and the single-stage transpedicular decompression and the posterior instrumentation groups. The correction loss in the anterior instrumentation group of our series was 6.8 ± 1.9°, comparable to the 9.4° loss in the series of Kim et al [ 15 ]. Similarly, the correction loss in the posterior instrumentation group in the present study was 6.1 ± 1.3°, comparable to the 3.4° loss in the series of Güven et al [ 12 ].…”

Section: Discussionsupporting

confidence: 87%

“…In the report of Jin et al [ 5 ], a mean of 18° of kyphosis correction was achieved after anterior instrumentation surgery in the adult group during the follow-up period. In contrast, Kim et al [ 15 ], who operated on 21 patients with Pott disease by anterior instrumentation, mentioned that although a 67.7s% correction (11.3°) was achieved initially, a correction of 83s% (9.4°) was lost at the latest follow-up. Lee et al [ 16 ] reported that the correction of the kyphotic angle and loss of correction were statistically significant (p < 0.05) in both the anterior instrumentation and fusion groups and the single-stage transpedicular decompression and the posterior instrumentation groups.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults

et al. 2013

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Objective: To investigate surgical methods and outcomes in the treatment of spinal tuberculosis (TB) in adults. Subjects and Methods: One hundred and eighty-one patients (average age 39 years) without multiple-level noncontiguous spinal TB were followed up for 22-72 months. The patients were divided into four groups according to surgical procedure on the basis of the position and extension of the foci: group A (74 cases): anterior radical debridement and strut grafting with instrumentation; group B (83 cases): posterior instrumentation and bone grafting with anterior radical debridement and strut grafting in a single- or two-stage procedure; group C (10 cases): extrapleural anterolateral decompression and strut grafting with posterior instrumentation in thoracic or thoracolumbar spine, and group D (27 cases): single-stage transforaminal decompression and posterior instrumentation and fusion. Results: There was a significant decrease (p < 0.05) in mean preoperative (81%) Oswestry's Disability Index. Except for 24 patients with lumbosacral TB who were only instrumented posteriorly, kyphosis degrees were corrected by a mean of 11.5° in the anterior instrumentation group and 12.6° in the posterior instrumentation group (p < 0.01). The correction loss was 6.8° in the anterior instrumentation group and 6.1° in the posterior instrumentation group at the last follow-up (p < 0.01). Conclusion: The four surgical procedures obtained good results for correction and maintenance of the correction, clearance of the foci, decompression of the spinal cord and pain relief in the treatment of spinal TB in adults, providing that the operative indication is accurately identified. However, the posterior approach was superior to anterior instrumentation for correcting deformity and maintaining the correction.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults

et al. 2013

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“…11 Kim et al who operated on 21 patients by anterior instrumentation, mentioned that although a 67.7% correction (11.3 ) was achieved initially, a correction of 83% (9.4 ) was lost at the last follow-up. 18 Lee et al Reported the correction of the kyphotic angle and loss of correction was statistically significant (p < 0.05) in both the anterior instrumentation and fusion groups and the single-stage trans-pedicular decompression and the posterior instrumentation groups. 19 Recently, posterior-only procedures with or without anterior reconstruction are state of the art for management of spinal TB.…”

Section: Discussionmentioning

confidence: 98%

Surgical outcomes of posterior trans-facetal decompression and stabilisation in tuberculous spondylodiscitis with neuro-deficit

Kire

Kundnani

Jain

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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Study design: Retrospective study. Purpose: To evaluate the functional, neurological and radiological outcomes of posterior trans-facetal decompression and stabilisation in tuberculous spondylodiscitis patients with neuro-deficit. Overview of literature: Spinal tuberculosis mainly involves anterior column and for that anterior approach has been the most frequently used surgical technique in the past as it allows direct access to the infected tissue providing a good decompression. However, anterior surgery is associated with higher morbidity which can be reduced by posterior trans-facetal approach. Materials and methods: The study included 100 Tuberculous Spondylodiscitis patients with neuro-deficit who underwent posterior trans-facetal decompression and stabilisation from 2009 to 2014. Demographic data, clinical parameters (back pain score-VAS, ODI), neurological status (Frankel's grade), radiological parameters (Kyphosis angle) and complications were evaluated. Results: Out of the total 100 patients there were 58 males and 42 females. 84 patients had thoracic and 16 had thoracolumbar region involvement. The mean age of the patients was 34.7 years. The extent of fixation was 2 segments in 52 patients and >2 segments in 48 patients. Postoperatively significant improvement in VAS (pre-op 6.5 ± 0.65 to post-op 1.73 ± 0.64) and ODI (pre-op 76.54 ± 6.96 to post-op 30.5 ± 6.56) were noted. The mean kyphosis angle was corrected from 22.33 ± 5.59 to 5.14 ± 1.32 . 86 patients showed at least 1 grade of improvement in neurology (Frankel's grading) and there was no deterioration in any patient. 3 patients developed superficial infection and 2 had an intra-operative dural tear. 94 patients showed bony fusion at 2 years follow-up. Conclusion: Posterior trans-facetal decompression and stabilisation is an effective procedure in the management of thoracic & thoracolumbar tuberculous spondylodiscitis patients with neuro-deficit. It offers circumferential decompression with stabilisation and also maintains kyphosis correction.

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“…[ 21 ] With the occurrence of graft subsidence, the vertebral screws may toggle, shift, migrate, or even pull out. Two studies [ 13 , 22 ] found that correction of the kyphosis angle and loss of correction were statistically significant in cases involving thoracic and thoracolumbar spinal tuberculosis, suggesting that anterior instrumentation is not efficacious for preventing correction loss in cases of spinal tuberculosis. Postsurgical deformities may also ensue from technical error.…”

Section: Discussionmentioning

confidence: 99%

“…In their study, 6.6% of cases showed strut graft failure, and full autograft integration was achieved in only 77% of the cases. Kim et al [ 13 ] reported that a correction of 67.7% (11.3°) was achieved initially by anterior instrumentation in 21 patients with Pott disease, but 83% of the correction (9.4°) had been lost at the last follow-up. In another study, [ 14 ] anterior decompression and fusion supplemented by the Kaneda device was performed for 20 patients with thoracolumbar burst fractures.…”

Section: Introductionmentioning

confidence: 99%

Posterior vertebral column resection for correction of thoracolumbar kyphosis after failed anterior instrumented fusion

Dai

et al. 2020

Medicine

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To explore the effectiveness of posterior vertebral column resection for failed thoracolumbar anterior instrumented fusion. Ten patients with anterior fusion with refractory pain, progressive neurological deficits, and kyphosis were recruited. Anterior removal of the implant and posterior vertebral column resection were performed. The mean operating time, intraoperative blood loss, kyphosis angle, visual analog scale pain score, Oswestry disability index, bone fusion time, and complications were assessed in a minimum 18-month follow-up. The mean operating time was 323.5 ± 63.6 minutes, with a mean blood loss of 1189 ± 253.4 mL. The mean preoperative kyphosis angle of 54.6° ± 8.0° immediately decreased to 4.8° ± 1.5° after revision surgery and eventually to 6.8° ± 1.3° at the final follow-up. The mean bone fusion time was 6.8 ± 1.2 months. All patients had satisfactory sagittal and coronal balance with no implant failure at the last follow-up. The average visual analog scale score was 6.2 ± 1.0 preoperatively, and it decreased to 2.6 ± 0.5 at the last follow-up. No patient suffered from neurological deterioration. The Oswestry disability index decreased from 39.8% ± 4.6% preoperatively to 24.5% ± 4.7% at the final follow-up. Complications occurred in 4 patients: 3 experienced tearing of the lung, and 1 had a superficial wound infection. Anterior removal of the implant and posterior vertebral column resection constituted a safe and effective revision surgery for patients with prior anterior fusion with rigid postsurgical deformities.

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Anterior Spinal Instrumentation in Treatment of Spinal Tuberculosis

Cited by 16 publications

References 1 publication

Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults

Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults

Surgical outcomes of posterior trans-facetal decompression and stabilisation in tuberculous spondylodiscitis with neuro-deficit

Posterior vertebral column resection for correction of thoracolumbar kyphosis after failed anterior instrumented fusion

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