Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

Jain, Anubha; Jain, Roopesh; Kiyawat, Vivek

doi:10.4184/asj.2017.11.1.31

Cited by 18 publications

(21 citation statements)

References 22 publications

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“…The ODI score was reduced to 34 (10–74) at 6 months after posterior instrumentation. These results are consistent with research by Jain et al According to Jain et al there was a decrease in VAS score from 8.7 preoperatively to 2.1 at 6 months postoperatively [ 8 ]. Improvements in VAS scores at 6 months post posterior instrumentation could occur due to spinal nerve decompression along with improvement in kyphosis deformity.…”

Section: Discussionsupporting

confidence: 92%

“…Another study by Okada et al reported superior outcomes with more loss of correction, small and shorter duration of hospitalization in posterior instrumentation compared with surgical technique without instrumentation [ 6 ]. Other studies reported improvement of HRQOL and pain control after posterior instrumentation in spondylitis tuberculosis [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018–2020: A cross sectional study

Tobing

Fachrisal

Junaidi

2021

Annals of Medicine and Surgery

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Introduction Spondylitis tuberculosis can cause changes in spinopelvic parameters including pelvic incidence, pelvic tilt, and sacral slope due to biomechanical changes of the spine. Posterior instrumentation is one of the modality for the treatment of spondylitis tuberculosis. However, in Indonesia, clinical and radiological outcomes after posterior instrumentation in tuberculosis of lumbar vertebrae are still rare. This study aims to investigate the clinical and radiological outcomes of patients with spondylitis tuberculosis of the lumbar vertebrae after posterior instrumentation. Method This study was a cross-sectional study in patients with spondylitis tuberculosis of the lumbar vertebrae who underwent posterior instrumentation in Cipto Mangunsukumo and Fatmawati Hospital. Subjects were collected through consecutive sampling. 23 subjects were collected and analyzed. Clinical and radiological outcomes before and after posterior instrumentation were compared. The clinical outcome included the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). The radiological outcome included sacral slope, pelvic tilt, pelvic incidence, and lumbar lordosis. Results The median age of the subjects was 31 (9–57) years with a female-majority (60,9%). The median of the total vertebral infected was 2 (1–4). Median of VAS score before surgery, 6 months after surgery, and 12 months after surgery were 9 (4–10), 4 (1–7), dan 2 (1–6) (p < 0,001) consecutively. Median of ODI score before surgery, 6 months after surgery, and 12 months after surgery were 70 (40–86), 34 (10–74), dan 12 (2–74) (p < 0,001) consecutively. There was no significant difference in spinopelvic parameters before and after the surgery. The difference of ODI score before and after the surgery inversely correlated with the difference of lumbar lordotic and sacral slope. Conclusion Posterior instrumentation could improve clinical outcomes in patients with spondylitis tuberculosis of the lumbar. Change of lumbar lordotic and sacral slope after posterior instrumentation led to an improvement of quality of life marked by the reduction of the ODI score.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018–2020: A cross sectional study

Tobing

Fachrisal

Junaidi

2021

Annals of Medicine and Surgery

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“…have found the greater correction of kyphosis in lumbar and lumbosacral as compared to thoracolumbar studies. [29] This is attributed to more rigid thoracic vertebrae with rib attachments. Segmental spinal fixation, such as the pedicles screw system, allows for additional procedures such as closing wedge osteotomy, interbody fusion using bone graft with or without cages.…”

Section: Discussionmentioning

confidence: 99%

Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

Jain

Sahu

Behera

et al. 2019

Journal of Neurosciences in Rural Practice

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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.

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“…На фоне определенной стабилизации эпидемиологической ситуации по туберкулезу за рубежом и в Россий-ской Федерации в течение последнего десятилетия, в том числе касающейся заболеваемости туберкулезным спондилитом, составляющим 1,0-2,5 случая на 100 тыс. населения [5,11,17,29,33,46,62], отмечаются увеличение доли пациентов с множественными и распространенными формами заболевания [12, 14, 15, 26-28, 37, 59, 62] и двукратный рост числа заболеваний, вызванных лекарственно устойчивыми формами микобактерий туберкулеза [14,17]. Кроме того, число послеоперационных инфекционных осложнений, регистрируемых у таких больных, достигло 6-12 % [4,14].…”

Section: Discussionunclassified

“…Показаниями для хирургического лечения являются очаг костной деструкции, паравертебральные и эпидуральные абсцессы, деформации позвоночника с выраженным кифозом, неврологические дисфункции [16,45,56]. Длительное время абсцессотомия, передняя декомпрессия спинного мозга и передний спондилодез были золотым стандартом в хирургии инфекционных спондилитов [2,6,7,16,18,19,22,23,[32][33][34]49] [1,9]. К недостаткам переднебокового доступа к позвоночнику можно отнести риск повреждения магистральных сосудов, недостаточную возможность коррекции кифоза и некоторую (в пределах 5-10 %) потерю коррекции деформации в послеоперационном периоде [1,9,22].…”

Section: Discussionunclassified

Ineffective One-Stage Surgical Treatment of Disseminated Tuberculous Spondylitis: A Clinical Case and Literature Review

Бурлаков¹,

Vishnevsky²

2018

Hir. pozvonoč.

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The paper presents a clinical case of ineffective one-stage surgical treatment of disseminated tuberculous spondylitis. Female patient with extensive destruction of the vertebrae was treated by simultaneously performed posterior decompression and drainage of the abscess and short posterior fixation using dynamic titanium nickelide implant. After 4 months, inadequate primary surgical sanitation of the inflammation focus through posterior approach resulted in the progression of tuberculosis lesions of the spine. After repeated staged surgical treatment, the patient achieved favorable outcome of the disease. A review of the literature on disseminated forms of tuberculosis spondylitis has shown that at present there are staged and singlestep approaches to the treatment of this disease. Most modern researchers of tuberculosis spondylitis tend to single-step combined operations.

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Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis

Cited by 18 publications

References 22 publications

Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018–2020: A cross sectional study

Clinical and radiological outcome analysis among patients with spondylitis tuberculosis of the lumbar vertebrae after correction and posterior instrumentation in cipto mangunkusumo and Fatmawati Hospital in 2018–2020: A cross sectional study

Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

Ineffective One-Stage Surgical Treatment of Disseminated Tuberculous Spondylitis: A Clinical Case and Literature Review

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