One-stage posterior approach in the treatment of consecutive multi-segment thoracic tuberculosis with kyphosis

Zhong, Nianbing; Kong, Jinhai; Sun, Zhengwang; Qian, Ming; Liu, Tielong; Xiao, Jianru

doi:10.5137/1019-5149.jtn.19263-16.2

Cited by 6 publications

(4 citation statements)

References 10 publications

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“…This treatment strategy can achieve complete debridement, ensure bone graft fusion efficacy, reduce the probability of the infection spreading, correct kyphosis, and prevent the progressive worsening of kyphosis after surgery [1, 3, 4]. However, this surgical strategy greatly increases the operative time, blood loss volume, surgical trauma, and incidence of perioperative complications [5–7]. In recent years, it has been reported that in cases of progressive single-segment spinal tuberculosis, surgery by a posterior approach can achieve complete debridement, decompression, bone fusion, and internal fixation and can effectively correct spinal kyphosis, which has the advantages of mild trauma, few perioperative complications, low cost, and short recovery time[8, 9].…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Tang

Yang

et al. 2019

J Orthop Surg Res

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Background The purpose of this multicentre, retrospective study was to evaluate the safety and efficacy of different surgical approaches for treating thoracolumbar tuberculosis. Methods This study reviewed 132 patients with thoracolumbar tuberculosis in six institutions between January 1999 and January 2015 surgically treated by an anterior-only approach ( n = 22, group A), an anterior combined with posterior approach ( n = 79, group B), and a posterior-only approach ( n = 31, group C). All patients were treated with standard antituberculosis drugs pre- and postoperatively and were followed regularly after surgery. Clinical symptoms, nerve function, and the erythrocyte sedimentation rate were observed, and kyphosis correction and bone fusion were evaluated by X-ray or computed tomography. Results At the last follow-up, all patients had achieved bone fusion, relief from pain, and neurological recovery. The Cobb angle was improved; however, the Cobb angle showed a degree of loss at the final follow-up after all three surgical approaches. Further comparisons revealed a difference in angle loss at the final follow-up among the three groups; groups B and C were superior to group A in maintenance of the correction. The posterior-only approach was characterized by a shorter operative time and reduced blood loss. Conclusions Surgery by a posterior-only approach is superior to that by an anterior-only approach and anterior combined with posterior approach in terms of permanent kyphosis correction and spinal stability maintenance. Therefore, we recommend surgery by a posterior-only approach as the optimized treatment for thoracolumbar tuberculosis if the indications for this treatment are met.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Tang

Yang

et al. 2019

J Orthop Surg Res

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“…In the studies by Jia et al, 10 the mean age of presentation was 45.9 ± 12.7 years, with a range of 27 to 69 years. The mean age of representation in the studies by Zhong et al 11 was 45.5 years, with a range of 19 to 76 years. Dai et al 12 in their studies found that the mean age of presentation of the disease was 43.8 ± 12 years, with an age range of 25 to 68 years.…”

Section: Discussionmentioning

confidence: 87%

Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

Susanta

Biswaranjan

Balappa

et al. 2021

Indian Journal of Neurosurgery

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Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time. Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval. Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications. Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

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“…With advancements in the posterior technique, some surgeons have begun to use posterior-only surgery to treat multisegment thoracic TB. Zhong et al [ 20 ] and Wu et al [ 21 ] treated TB patients with multisegment lesions and kyphosis by posterior-only surgery, and all patients were cured and had no recurrence of TB. For multisegment thoracic and lumbar TB, posterior surgery can be performed with multisegment transforaminal and paravertebral approaches according to the type of lesion; in some indirect operations, the lesion surrounding the spine can be effectively cleared, and the case of TB can be cured [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach

et al. 2020

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Purpose: To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis. Methods: Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores, and complications were compared between the two groups. Results: There was no significant difference in the operation time or blood loss between groups A and B (P > 0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2 ± 15.2°and 27.9 ± 7.7°, respectively, which significantly decreased to 4.9 ± 11.8°and 10.4 ± 5.6°after the operation, respectively (P < 0.05). At the final follow-up, the angles were 7.1 ± 10.5°and 14.6 ± 8.0°. The correction angle and correction rate in group A (31.3 ± 16.6°, 88.6 ± 43.6%) were greater than those in group B (17.5 ± 4.4°, 64.9 ± 14.0%) (P < 0.05). There was no significant difference in the loss angle between groups A and B (P > 0.05), but the loss rate in group B (24.0 ± 27.8%) was higher than that in group A (9.6 ± 10.2%) (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusion: The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.

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One-stage posterior approach in the treatment of consecutive multi-segment thoracic tuberculosis with kyphosis

Abstract: The one-stage posterior approach of debridement and drainage is a feasible surgical option for consecutive multisegment thoracic tuberculosis with kyphosis. It can achieve debridement, decompression, and stabilization simultaneously.

Cited by 6 publications

References 10 publications

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach

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