One-Stage Lateral Rhachotomy and Posterior Spinal Fusion with Compression Hooks for Pott's Paralysis in the Elderly

Abstract

Purpose. To evaluate the safety and effectiveness of one-stage lateral rhachotomy and posterior fusion with compression hooks, for the treatment of Pott's paralysis in the elderly. Methods. 11 elderly patients underwent lateral rhachotomy (costotransversectomy and pediculectomy) to debride the tuberculosis focus extending into the epidural space and to decompress the spinal cord. After debridement, the interbody cavity was packed with autologous iliac bone chips. For stabilisation, posterior fusion was performed using a compression lamina hook system. Patients were followed up for at least 2 years for complications. Neurological status was assessed using the Frankel score. The kyphotic deformity was measured on lateral radiographs taken before surgery and at follow-up. Results. During separation of the adhesion around the abscess, a dural tear occurred in one patient and a pleural tear in another. Both tears were successfully repaired. One patient had mild pneumonia after surgery. The Frankel scores of the 11 patients improved from C or D before surgery to D or E One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott's paralysis in the elderly Surgery 2006;14(3):310-4 after surgery. No relapse of spinal tuberculosis was encountered. The mean deformity angle was 25.5 degrees before surgery and 23.2 degrees at the final follow-up. Spinal fusion was achieved in all patients. Conclusion. Without the need of thoracotomy, onestage lateral rhachotomy with posterior spinal fusion using compression hooks was an effective option for treating Pott's paralysis in the elderly. Journal of Orthopaedic

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

“…h Magnified lateral X-ray showing the expandable cage filled and surrounded by bone graft spanning the interval between L2 and L5 vertebrae. i Sixmonth follow-up sagittal CT external support or the addition of posterior fusion in a second stage surgery, what constitutes two-stage circumferential fusion [16,17].…”

“…This persuaded some workers to do a second stage posterior fusion with instrumentation to avoid these complications [15]. This was further developed by doing anterior and posterior surgery in one operative session [16][17][18][19][20][21][22].…”

Tuberculosis of ultralong segmental thoracic and lumbar vertebrae treated by posterior fixation and cleaning of the infection center through a cross-window

“…These options increase the surgical trauma or extend the treatment cycle. Posterior internal fixation can be combined with lesion debridement through the transverse process of the ribs through one incision [20]. However, traditional costotransversectomy is rarely applied in long segmental lesion debridement because it requires the resection of the ribs and intercostal nerve.…”

“…Because of the extensive scope of ultralong segmental spinal TB and its associated poor spine stability, surgical approaches for this disease must ensure both thorough debridement and effective internal fixation. The prevailing operation methods for ultralong segmental spinal TB are: anterior extrapleural and extraperitoneal lesion debridement, bone grafting, and internal fixation through the chest; posterior fixation and one-or two-stage anterior lesion debridement with double incisions [19]; and posterior pedicle system correction and fixation using one skin incision in patients with poor cardiopulmonary function, to avoid affecting the thoracic cavity, followed by front lesion debridement and intervertebral bone graft fusion through the transverse processes of the ribs [20].…”

Single-Stage Posterior Instrumentation for Progressive Tubercular Thoracic and Thoracolumbar Kyphosis

“…9 With advances in posterior techniques and systems, the posterior approach has become increasingly popular and avoids the morbidity of anterior surgery. [10][11][12][13][14][15] It enables access to both the anterior and posterior aspects of the spine through a single incision. 16 Appropriate case selection is more important than the surgical method to obtain a favourable outcome.…”