Surgery-Related Complications and Sequelae in Management of Tuberculosis of Spine

Abstract

Study DesignMedical record-based survey.PurposeTo survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery.Overview of LiteratureThere is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems.MethodsThere were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients.ResultsThere were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults).ConclusionsThe safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected.

Treatment of Extreme Tuberculous Kyphosis Using Spinal Osteotomy and Halo-Pelvic Traction

“…[8][9][10] These techniques take a one-stage correction for spine deformity, and undoubtedly increase surgicalrelated complications, such as large-vessel injuries, neurological injuries (cord, roots, nerves), dural tears, and stabilization failure. 11 Halopelvic traction corrects spinal deformities successfully, since be demonstrated. 1 But it is not popular recently for its shortcoming.…”

Tetraplegia associated with post-operative syringomyelia in spinal tuberculosis: a result of an epidural compartment syndrome?

“…However, in both of these cases the cause was attributed to a pre-existing intradural-extramedullary tuberculoma with concurrent arachnoiditis. Moon et al [3] in one of the largest studies on surgery-related complications of spinal tuberculosis did not report a single case of post-operative syrinx formation.…”

“…For such patients, surgical spinal decompression along with anti-tubercular drug therapy is the usual mode of management. However, lack of neurological recovery or even further neurological deterioration can occur in around 10% of such patients after surgical spinal decompression [3]. Neurological deterioration in these patients can be due to inadequate decompression, multi-drug resistant organisms, physical damage to the spinal cord, or damage to the vascular supply of the spinal cord.…”

Current Concepts on Spinal Tuberculosis

“…al. (35) , in their study on 901 patients who underwent spinal tuberculosis surgery, reported increasing of the corrected kyphosis angle (32%) and graft failure (14%) as the most common complications associated with the disease. In the same study, thoracic cavity complications (43%), thrombophlebitis (26%) and sympatheticolysis symptoms (32%) were reported as surgical complications, especially in the anterior approach.…”