Single-stage Transpedicular Decompression and Posterior Instrumentation in Treatment of Thoracic and Thoracolumbar Spinal Tuberculosis

Lee, Sun-Ho; Sung, Joo-Kyung; Park, Yeun-Mook

doi:10.1097/01.bsd.0000211241.06588.7b

Cited by 122 publications

(92 citation statements)

References 33 publications

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“…Some scholars have expressed concern that lesions confined to the vertebral body could spread to the lamina of the vertebra and spinous process to result in infectious meningitis. However, standard antituberculosis chemotherapy can prevent recurrence and metastasis of tuberculosis [4,18,19], while the current relevant literature and our study show that such complications are rare [19,20]. Compared with patients treated with anterior approach, patients treated with posterior approach are more conducive to drainage of residual lesions postoperatively in the supine position because of gravity.…”

Section: Discussionmentioning

confidence: 68%

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

et al. 2012

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Purpose To investigate the clinical efficacy and feasibility of one-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterioronly approach. Methods Fourteen patients (eight males, six females) with upper thoracic tuberculosis whose lesions were confined to two adjacent segments were admitted to our hospital. Their ages ranged from 23 to 72 years (average, 50 years). The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. ASIA classification showed that preoperatively, one patient was grade A, two patients were grade B, eight patients were grade C, and three patients were grade D. All patients were treated with one-stage surgical treatment by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach. Patients were evaluated preoperatively and postoperatively by measurement of thoracic kyphotic angles using Cobb angle evaluation, determination of erythrocyte sedimentation rate (ESR), evaluation of ASIA impairment scale, and radiological examination. Results Operation time ranged from 70 to 135 min, (average, 110 min). Intraoperative blood loss ranged from 200 to 950 mL (average, 450 mL). All patients were followed up for 22 to 48 months postoperatively (average, 31.5 months). No sinus tract formation, cerebrospinal meningitis, or recurrence of tuberculosis occurred. All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 12°-26°postoperatively, and at final follow-up were 13°-28°. The ESR recovered to normal within 6 months postoperatively in all patients. Bone fusion was achieved within 3-8 months (average, 5.5 months). Conclusions One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method.

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Section: Discussionmentioning

confidence: 68%

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

et al. 2012

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“…These authors have used segmental spinal instrumentation with pedicle screws and rods. In most of these reports, additional procedures such as posterior closing wedge osteotomy, and posterior inter-body fusion using bone grafts with or without cages have been performed [37,[39][40][41][42][43][44].…”

Section: Discussionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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“…In the literature, there is one report comparing the anterior approach with the posterior approach for spinal tuberculosis. Lee et al [5] reported their experiences with the anterior or posterior approaches combined with internal fixation for thoracolumbar tuberculosis. They concluded that there was no difference in outcomes between groups and that the posterior approach was useful for treating early-diagnosed thoracic and thoracolumbar spinal tuberculosis for the following indications: (1) <50% collapse of the vertebral body, and (2) mild kyphosis (<30°).…”

Section: Group (N)mentioning

confidence: 99%

“…Posterior instrumentation has become popular as a technique to correct angular deformities and stabilise an unstable spine. Several authors have reported that the use of the posterior approach combined with debridement and instrumentation to treat spinal tuberculosis has led to favourable clinical outcomes [5][6][7]. However, the posterior approach remains controversial because it may affect posterior spinal column stability [8,9].…”

Section: Introductionmentioning

confidence: 99%

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

Zhou

et al. 2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to compare posterior and anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. These approaches were compared in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis. Methods Forty-seven patients with thoracic and lumbar tuberculosis who underwent either the posterior or the anterior approach in combination with debridement, interbody autografting and instrumentation from January 2004 to March 2010 were reviewed retrospectively. In group A (n=25), the posterior approach was combined with debridement, interbody autografting and instrumentation. In group B (n=22), the anterior approach was performed in addition to debridement, interbody autografting and instrumentation. Results All cases were followed up for 12-62 months. There was no statistically significant difference between groups in terms of the operation duration, intraoperative blood loss, bony fusion, intraoperative and postoperative complications, neurological status and the angle of kyphosis (p>0.05). Good clinical outcomes were achieved in both groups. ConclusionsThe posterior approach combined with debridement, interbody autografting and instrumentation is an alternative procedure to treat thoracic and lumbar tuberculosis. The posterior approach is sufficient for lesion debridement. In addition, the posterior approach can maintain spinal stabilisation and prevent loss of corrected vertebral alignment as effectively as the anterior approach.

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Single-stage Transpedicular Decompression and Posterior Instrumentation in Treatment of Thoracic and Thoracolumbar Spinal Tuberculosis

Abstract: The posterior decompression with transpedicular instrumentation can be an alternative treatment method of less-involved spinal tuberculosis especially for patients in early phase of bone destruction or ones with mild kyphosis.

Cited by 122 publications

References 33 publications

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis

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