Surgical Management of Spinal Tuberculosis—The Past, Present, and Future

Ruparel, Sameer; Tanaka, Masato; Mehta, Rajeshwari R.; Yamauchi, Taro; Oda, Yoshiaki; Sonawane, Sumeet; Chaddha, Ram

doi:10.3390/diagnostics12061307

Cited by 21 publications

(20 citation statements)

References 70 publications

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“…Then, the anterior column was reconstructed using autograft, allograft, or vertebral body spacers. For obtaining an immediate stability, supplemental posterior instrumentation after anterior column reconstruction in a single- or two-stage manner could be carried out through additional posterior approach [ 22 , 23 ]. This combined surgery is the most secure procedure for patients with severe deformity, instability, and neurologic deficit.…”

Section: Discussionmentioning

confidence: 99%

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

et al. 2022

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Background Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique. Methods Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI). Results All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7–8) before surgery and decreased to 2.1 (range, 1–3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70–84) preoperatively to 25.5 (range, 22–28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively. Conclusions In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

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Section: Discussionmentioning

confidence: 99%

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

et al. 2022

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“…Then the anterior column was reconstructed using autograft, allograft, or vertebral body spacers. For obtaining an immediate stability, supplemental posterior instrumentation after anterior column reconstruction in a single-or two-stage manner could be carried out through additional posterior approach [24,25]. This combined surgery is the most secure procedure for patients with severe deformity, instability, and neurologic de cit.…”

Section: Discussionmentioning

confidence: 99%

Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using fibular allograft in Patients with Skipped Multifocal Spinal Tuberculosis

Chiu

Yang

Kao

et al. 2022

Preprint

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Background: Skipped multifocal spinal tuberculosis (TB) is an atypical presentation of spinal TB. Surgical treatment for these unusual cases remains a challenge for spine surgeons. In our institute, we used single-stage circumferential debridement and anterior reconstruction with fibular allograft followed by posterior instrumentation through posterior-only approach for these patients. This study aimed to determine the efficacy and feasibility of this technique.Methods: Twelve patients with skipped multifocal spinal TB who received our treatment method from January 2012 to June 2020 were enrolled in this study. The visual analog score (VAS), laboratory data, comorbidities, complications, and neurologic status based on Frankel scale were recorded. The patients’ clinical conditions were evaluated based on modified Brodsky’s criteria and Oswestry Disability Index (ODI).Results: All the patients were infection free at the end of the treatment. The average VAS score was 7.5 (range, 7 to 8) before surgery and decreased to 2.1 (range, 1 to 3) one year postoperatively. No one experienced any severe complications such as neurologic deterioration, fixation failure, or bone graft dislodgement. Out of the three patients requiring debridement surgery, two had wound infection and one had seroma formation. The ODI score improved from 76.8 (range, 70 to 84) preoperatively to 25.5 (range, 22 to 28) one year after surgery. All patients achieved good or excellent outcome based on modified Brodsky’s criteria one year postoperatively.Conclusions: In our study, the patients could achieve a good clinical outcome. This technique could be an alternative for patients with skipped spinal TB.

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“…So far, the commonly used surgical treatment methods include the anterior approach, posterior approach, anterior and posterior approach combined with debridement, and bone graft fusion. However, there were still controversies about surgical methods [7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…For surgical methods, there are simple anterior approach, simple posterior approach, and anterior and posterior approach combined with debridement and bone graft fusion. However, the selection of surgical methods is still controversial [7][8][9][10][11]. At the same time, a weakened immune system due to HIV infection could increase the risk of perioperative, including opportunistic infections and various surgical complications such as surgical site infection, sepsis, et al Hence, risk assessment and the timing of surgical treatment are critical [12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis

et al. 2022

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Objective We aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis. Methods From October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time. Results In the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all < 0.05). No tuberculosis recurrence was found at the last follow-up, ESR and CRP returned to normal, and there were no statistically significant differences in bone graft fusion time, VAS score, ASIA scale, correction rate of kyphosis, and angle loss between two groups (P all > 0.05). Conclusion Single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications.

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Surgical Management of Spinal Tuberculosis—The Past, Present, and Future

Cited by 21 publications

References 70 publications

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

Single posterior approach for circumferential debridement and anterior reconstruction using fibular allograft in patients with skipped multifocal spinal tuberculosis

Single Posterior Approach for Circumferential Debridement and Anterior Reconstruction Using fibular allograft in Patients with Skipped Multifocal Spinal Tuberculosis

Efficacy of single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis

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