Operative treatment of progressive deformity in spinal tuberculosis

Abstract

We report on 14 patients with tuberculosis of the spine treated by operation. All had disease of three or more vertebrae with involvement of both the anterior and posterior columns and a progressive kyphotic deformity in spite of conservative treatment. We consider such spines to be 'unstable' and have found that anterior as well as posterior fusion with instrumentation is necessary.Résumé Nous rapportons 14 cas de patients atteints de tuberculose rachidienne traitée chirurgicalement. Tous avaient une affection de trois vertèbres ou plus, avec une atteinte de la colonne antérieure et de la colonne posté-rieure et une cyphose progressive malgré le traitement conservateur. Nous avons considéré de telles colonnes vertébrales 'instables' et avons trouvé qu'une double instrumentation, antérieure et postérieure était nécessaire.

Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity

“…Thus, anterior debridement combined with posterior fusion and fixation was developed [3,10,12,13,[25][26][27], which enables immediate and sufficient stabilization after kyphosis correction. Table 4 summarizes published reports focused on treatment of active spinal tuberculosis with kyphosis of more than 30°.…”

“…Tuberculosis of the thoracic and lumbar spine causing gross destruction of the anterior and middle columns often leads to kyphotic deformity [2,3]. Rajasekaran and Shanmugasundaram [4,5] reported that, among children treated conservatively, only 44% experienced improvement of the deformity, while in the remaining patients there was no change (17%) or deterioration (39%); in particular, kyphosis of more than 60°developed in 3-5% of cases.…”

A new classification and guide for surgical treatment of spinal tuberculosis

“…These cases can only be treated surgically [2,3,28]. There are several surgical techniques: abscess drainage [7,10], anterior strut grafting [12,19], anterior instrumentation [8,27], posterior instrumentation [14,18], combined anterior and posterior stabilisation [6,9] and video-assisted minimally invasive thoracoscopic spinal operations [16].…”

“…In summary, abscess drainage and debridement enhance drug treatment [22]; biopsy specimens can be taken efficiently for histopathological diagnosis [10,21]; local instability and disc degeneration are treated by fusion, which prevents pain and the development of deformity [3,10]; decompression is provided in cases with neurological problems [19]; if there is any deformity, it can be corrected [14,18]; surgical treatment leads to rapid recovery and early mobilisation [5,21].…”

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

“…To promote neurological improvement 15 and facilitate early patient ambulation, 16 the spine should be stabilised after debridement and decompression. The curetted interbody cavity is packed with bone grafts after decompression.…”