Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Abstract

Background: A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion.Methods: A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity.Results: The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P , .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively.Conclusions: Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity.

Postoperative Neurological Outcome in Spinal Tuberculosis Patients Presenting with Severe Neurological Deficits

“…They found no such difference in patients presented with ASIA A B or C preoperatively. 11 They found 87% recovery in patients of ASIA A or B and 93% recovery in patients of ASIA C. This study showed that 27 patients had ASIA B preoperatively 6 patients improved in 3-6 months and 19 improved in 9-15 months with p value 0.12. This showed no significant relation of improvement in patients of ASIA B.…”

“…This was followed by cage fusion. 10,11 In 8 patients anterior trans-cervical approach was done and in 6 patients posterior approach was done. The anterior cervical approach was good in providing adequate decompression and anterior stabilization.…”

“…The spinal cord status and nerve root compression are very clearly demonstrated on MRI. 10,11 Sometimes the diagnosis is not clear, so tissue diagnosis with needle biopsy under CT guidance is required to obtain tissue diagnosis. This aspiration also helps in drainage of pus which also improves the pain of the patient.…”

Multiple Spinal Tuberculosis with Severe Kyphosis: A Case Report

“…Scoliosis due to spinal tuberculosis is usually associated with cumulative sagittal and coronal plane imbalance (4). Thoracolumbar kyphosis could be surgically treated with a 66% corrective effect (6). The effect of sagittal correction was still the same after a long follow-up (7).…”

Blood transfusion risk prediction in spinal tuberculosis surgery: development and assessment of a novel predictive nomogram

“…Surgery is required when conservative treatment for spinal tuberculosis fails due to drug resistance [ 4 , 5 ]. Surgical approaches include anterior, posterior, and combined anteroposterior approaches [ 6 , 7 ]. Regardless of the surgical approach, preoperative blood preparation is essential for the perioperative period [ 8 ].…”