Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

Zhang, Hong Qi; Li, Jin Song; Zhao, Shu Shan; Shao, Yu Xiong; Liu, Shao Hua; Gao, Qi; Lin, Min Zhong; Liu, Jin Yang; Wu, Jian; Chen, Jing

doi:10.1007/s00402-012-1618-0

Cited by 72 publications

(93 citation statements)

References 27 publications

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“…The correction of Cobb's angle was 15.4 ± 5.0°in group B patients, and was effective in maintaining correction, with an average loss of 1.4 ± 0.8°, which is similar to the data reported in the literature. 19,20 Accordingly, in our study, the posterior approach achieved equally good results compared with the combined approach in terms of deformity correction and bone fusion.…”

Section: Discussionsupporting

confidence: 52%

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Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged

et al. 2015

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Study design: Retrospective case-control study. Objectives: To analyze the results of two surgical treatments for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Methods: We studied 33 cases of lower lumbar spinal tuberculous spondylitis treated in our center from January 2006 to October 2010. The cases were divided into two groups: 16 cases (group A) underwent single-or two-stage anterior debridement, bone grafting and posterior instrumentation, and 17 cases (group B) underwent single-stage posterior debridement, decompression, interbody fusion and instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Results: Patients were followed for a mean of 41.3 months (range 36-48 months). The average operative durations were 276.9 ± 23.8 and 193.8 ± 22.5 min in groups A and B, respectively. The average hospital stay was 18.2 ± 3.2 days for group A and 13.4 ± 1.6 days for group B. Average intraoperative blood loss for groups A and B was 1187.5 ± 163.0 and 804.7 ± 134.1 ml, respectively. Operative complications affected four patients in group A and one in group B. Solid fusion occurred at 12 months in the other 32 cases. Neurological status was significantly improved in all cases. Kyphosis was significantly corrected after surgical management, but loss of correction occurred in both groups. Conclusion: Single-stage posterior debridement, decompression, interbody fusion and instrumentation might be a better surgical treatment than combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged, offering fewer complications and a better quality of life.

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Section: Discussionsupporting

confidence: 52%

“…Some authors 18,19 have previously proposed combined anterior and posterior surgery for treating lower lumbar TB. Although this approach can achieve complete debridement and firm fixation, it is still controversial.…”

Section: Discussionmentioning

confidence: 99%

Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged

et al. 2015

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“…Despite ongoing efforts by the World Health Organization and local health authorities, TB remains prevalent in certain developing countries, affecting all susceptible individuals (14). Over the last 50 years, various methods for surgical debridement and fusion have been described for spinal TB (1,10,15).…”

Section: Discussionmentioning

confidence: 99%

Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study

Zhang¹,

Wang²,

Shen³

et al. 2015

Experimental and Therapeutic Medicine

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Abstract. The aim of this retrospective study was to analyze the results of two surgical treatments for thoracic and lumbar spinal tuberculosis. A total of 73 patients with monosegmental thoracic or lumbar spinal tuberculosis were enrolled from January 2006 to April 2011. The patients were divided into two groups. Patients in group A (n=34) underwent one-stage posterior debridement, limited decompression, bone grafting and internal fixation combined with lamina reconstruction, while those in group B (n=39) underwent one-stage posterior debridement, decompression, bone grafting and posterior instrumentation. Clinical and radiographic results were analyzed and compared between the groups. Patients were followed for a mean 31.3 months (range, 21-42 months). Fusion occurred at 4-12 months (mean, 7.7 months). Surgical complications affected one and five patients in groups A and B, respectively. There was extraction of internal fixation in two group B patients. Postoperatively, there was significant Cobb angle correction in the two groups. By the last follow-up, the Cobb angle and correction loss in group A were significantly better than that in group B; the group A Oswestry Disability Index and Frankel grade were better than that in group B.In conclusion, one-stage posterior limited decompression, bone grafting and internal fixation combined with lamina reconstruction enables rapid management of monosegmental thoracic and lumbar spinal tuberculosis with fewer complications and minimal invasion. IntroductionAs the most common form of extrapulmonary tuberculosis (TB), spinal TB has remained prevalent worldwide, particularly in the less developed and developing countries (1,2), occurring in 1.7% of the world population (3) and accounting for almost 50% of cases of skeletal TB (4). Additionally, it can be the most dangerous form of skeletal TB due to its capacity for causing bone destruction, deformity and paraplegia (5). Anti-tuberculous chemotherapy has proven effective in the majority of cases and has become the mainstay of treatment (6), yet it cannot prevent kyphotic degeneration (7,8). Surgery is therefore frequently imperative for spinal decompression (9).Various surgical methods have been described for treating spinal TB. While there are advantages to exposing the pathological site directly and resecting damaged vertebrae, sequestra of disc and bone, and tuberculous granuloma, which cause predominantly anterior compression of the spinal cord, have led certain authors (10,11) to consider the anterior approach too invasive and often unnecessary in the context of spinal TB. The anterior approach may also involve division of the diaphragm and segmental spinal vessels. An increasing number of surgeons have adopted the method of posterior debridement, bone fusion and posterior fixation to treat monosegmental spinal TB. However, complications resulting from damage to the posterior spinal column due to the posterior approach reduce the surgical effect and affect the patient's quality of life (12). A procedure that caused...

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“…The data on operation time of the surgery was available in 4 studies (24)(25)(26)(27), consisting of 237 patients (group A, 118; group B, 119). The randomeffects model was applied to determine the operation time between the 2 groups due to the evidence of heterogeneity (c 2 ¼ 67.5, I 2 ¼ 96%, P< 0.01).…”

Section: Results Of Data Analysismentioning

confidence: 99%

“…Whether the clinical outcomes of the single posterior approach for the treatment of spinal TB are superior to the combined posterior and anterior approach still remains a subject of controversy (20,(24)(25)(26)(27). To achieve an integrative understanding of the clinical response of patients who underwent the posterior approach (group A) or the combined posterior and anterior approach (group B), a systematic review of relevant controlled trials and a meta-analysis was conducted to clarify the differences in these 2 approaches.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and Safety of Posterior Versus Combined Posterior and Anterior Approach for the Treatment of Spinal Tuberculosis: A Meta-Analysis

et al. 2015

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Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

Cited by 72 publications

References 27 publications

Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged

Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged

Two one-stage posterior approaches for treating thoracic and lumbar spinal tuberculosis: A retrospective case-control study

Efficacy and Safety of Posterior Versus Combined Posterior and Anterior Approach for the Treatment of Spinal Tuberculosis: A Meta-Analysis

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