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

Ahsan, Kamrul; Sakeb, N

doi:10.1177/1602400314

Cited by 3 publications

(2 citation statements)

References 30 publications

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“…13 If the reason for surgery is to prevent kyphosis, its best to operate early when the kyphosis is not excessive, with no proven benefit in late stages. 14 Compared to thoracic spine, lumbar caries seems to demonstrate less risk of kyphotic deformity. 15 Literature review reveals that patients with minimum neurological deficit and undergoing earlier surgery fare better than patients with severe deficits and later surgery.…”

Section: Pre-operative Post-operative P Valuementioning

confidence: 99%

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

et al. 2020

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Objective: To compare short term outcome of combined surgical and medical management versus medical management alone in caries spine.Material and Methods: This study was conducted from August 2015 to August 2018, on 68 patients randomly divided into two groups of 34 each. All were diagnosed cases of Caries spine based on history, clinical examination, ESR and imaging appearances. Group A underwent surgical intervention along with Anti-Tuberculous Treatment (ATT) while Group B received medical treatment (ATT) alone. Results: There were 37 (54.41%) males and 31 (45.59%) females with mean age of 34.84 ± 10.6 years. The thoracic spine was the commonest site in 33 (48.5%) patients, followed by lumbar in 20 (20.8%), dorso-lumbar in seven (10.3%) and cervical in four (5.88%) patients. The ESR fell from 85mm/hr to 24.46mm/hr in Group A and to 41.92mm/hr in Group B (p = 0.0124). Overall improvement in Frankel grade was seen in 25 (73.5%) patients in Group A and 12 (35.3%) in group B. In group A, improvement seen from grade A in two (8%), grade B in three (12%), grade C in 12(48%), Grade D in seven (28%) patients, (p = 0.000) while eight (23.5%) patients remained same and only one (2.5%) deteriorated from baseline neurological status. In Group B, 16 (47%) patients remained same and six (17.6%) deteriorated. Conclusion: Surgery combined with antituberculous therapy was found to be beneficial in patients suffering from caries spine and to be recommended to patients desiring rapid recovery

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Section: Pre-operative Post-operative P Valuementioning

confidence: 99%

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

et al. 2020

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“…[1] In the late stage, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations and increased risk of neurologic involvement [2,3]. Deformity more commonly occurs and rapidly progresses in the thoracic spine [4]. The surgical treatment of deformity in the thoracic region poses a challenge to the spine surgeon because its high neurological risk [5].…”

Section: Introductionmentioning

confidence: 99%

A new surgical treatment for post-tubercular thoracic kyphosis, a retrospective study.

Liu

et al. 2020

Preprint

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Background: In the late stage of Spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations. Deformity more commonly occurs and rapidly progresses in the thoracic spine. The surgical treatment of deformity in the thoracic region poses a challenge to the spine surgeon because its high neurological risk. Vertebral column decancellation，a new spinal osteotomy technique, is thought to be suitable for most patients with severe rigid kyphosis. In the current study, we report VCD technique as another surgical strategy for correction of post-tubercular thoracic kyphosis and evaluate the clinical and radiographic patient results.Methods: Between January 2016 and January 2018, 16 patients with post-tubercular thoracic kyphosis underwent the Vertebral column decancellation. Preoperative and postoperative Konstam’s angle were measured. Oswestry Disability Index(ODI) ,Visual analog scale(VAS) and American Spinal Injury Association(ASIA) were documented. The mean follow-up was 31.4 months Results: The average operation time was 226 minutes (range, 200–260 minutes) with a mean intraoperative blood loss of 466 mL (range, 400–580 mL).The Konstam’s angles decreased from 88.8°(range, 76°–103°)preoperatively to 19.0°(range, 9°–32°)at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 7.0(range, 6–8) to 1.7 (range, 1–3, P<0.01) and the ODI improved from 67.6% (range, 59%–77%) to 20.7% (range, 15%–33%, P<0.01). At final follow-up, there was radiographic evidence of solid fusion at the osteotomy site and fixed segments in all patients. Neurological function improved from ASIA scale D to E in 6 patients, C to D in 3 patients.Conclusion: Our results suggest that VCD is a safe and effective treatment option for post-tubercular thoracic kyphosis. This technique achieves higher correction and fusion rates with adequate decompression of neurological elements.

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Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach

Zheng¹,

Shuan²,

Hu³

et al. 2017

IJCM

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Objective: To evaluate the clinical feasibility and efficacy in treatment of thoracic tuberculosis via paraspinal approach. Methods: From June 2011 to August 2016, 24 patients with mono-segmental thoracic spine tuberculosis were treated by transfacet debridement combined with bone grafting and internal fixation through paraspinal approach. There were 11 males and 13 females with age ranging from 21 to 63 years (average, 39.5). There were 3 patients in T 4/5 , 2 patients in T 5/6 , 3 patients in T 7/8 , 3 patients in T 8/9 , 4 patients in T 9/10 , 3 patients in T 10/11 , and 6 patients in T 11/12 . Patients had different degraded local kyphosis deformity shown on X-ray, and different degraded bone destruction and abscess in thoracic spine shown on CT and MRI before the operation. All of the patients before the regular anti tuberculosis treatment for 2 to 4 weeks, the surgical approach used by paraspinal muscle approach, postoperative regular anti tuberculosis treatment for 9 to 12 weeks. Record the clinical symptoms of patients before and after surgery, preoperative Frankel functional classification of spinal cord injury, the operative time, intraoperative blood loss, postoperative ESR, CRP, complications, VAS score, ODI score and Cobb angle changes, imaging check regularly to evaluate the fusion and follow-up of nerve functional recovery. Results: The average operation time was 198 min. The average blood loss was 436 ml. There were no severe complications during and after operation. All patients were followed up for 1 year to 2 years, average 1.5 years of follow-up, the clinical symptoms improved significantly after operation and last follow-up ESR, CRP, VAS score, ODI score and Cobb angle were significantly improved after operation (P < 0.05), grade I Eck fusion, the fusion rate was 100% and the neurological function were improved. Conclusion: on the basis of strict anti tuberculosis chemotherapy, the use of paraspinal muscle gap approach for the treatment of thoracic tuberculosis is less invasive, less destructive to spinal stability, and can achieve obvious curative effect. It is worthy of clinical application.How to cite this paper: Zheng, J.P., Liu,

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

Abstract: Purpose. To review the outcome of single-stage posterior instrumentation for progressive tubercular thoracic and thoracolumbar kyphosis in 45 patients. Methods. Records of 16 men and 29 women aged 20 to 59 (mean, 34

Cited by 3 publications

References 30 publications

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

Caries Spine: A Comparative Study between Medical Management Alone with Combined Medical and Surgical Management

A new surgical treatment for post-tubercular thoracic kyphosis, a retrospective study.

Treatment of Thoracic Spine Tuberculosis by Paraspinal Muscle Gap Approach

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