Outcome analysis of anterior reconstruction with rib grafts in tuberculosis of the thoracic spine

Abstract

Introduction: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. Subjects and Methods: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. Results: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. Discussion: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The “Versatile approach” used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. Conclusion: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.

Comparative evaluation of multi-fold rib and structural iliac bone grafts in single-segment thoracic and thoracolumbar spinal tuberculosis: clinical and radiological outcomes

“…Rib bone grafts are known for their biological potential and ability to achieve rapid bone fusion [ 32 – 34 ], our study revealed that all patients who received the autogenous multi-fold rib graft achieved bony fusion within an average duration of 7.97 ± 2.34 months. A notable advantage of the rib graft is the absence of a need for an extra incision: the rib bone strut required for grafting is excised during routine anatomical dissection of the surgical procedure.…”

Patient Positioning in Spine Surgery: What Spine Surgeons Should Know?

“…When anterior spinal surgery and transpleural approaches were commonly used to approach anterior pathologies such as spinal tumors and spinal tuberculosis and perform anterior column fixation, the lateral decubitus position in spine surgery was popular [ 66 , 67 ]. With the development of dependable posterior fixation techniques and access to the anterior column via posterior approaches, the use of anterior approaches in spine surgery has decreased.…”

“…-Cardiac parameters least affected [42] -Restores lumbar lordosis [57] -Abdomen free and chest and pelvis fully supported [42] -No significant alteration in dynamic pulmonary compliance [59] -Use of image intensifier easy as table radiolucent and free space available -Lower blood loss, low mean airway pressure, and lower intraabdominal pressure compared to Wilson frame [60] -Large and bulky frame [63] -Difficult for the anesthetist to access airway due to large ends of the table [63] -Table height adjustment tedious [63] (Allen's frame) 5 Chest rolls -Cardiac parameters least affected [42] -Significantly decrease dynamic pulmonary compliance [59] -Limited support spine surgery was popular [66,67]. With the development of dependable posterior fixation techniques and access to the anterior column via posterior approaches, the use of anterior approaches in spine surgery has decreased.…”