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

Abstract

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...

A prospective study of functional outcome in Thoracolumbar potts spine with posterior only approach

“…The majority of the patients were pain-free at final followup. In a study by Zeng et al 13, The preop ODI scores among the study (69) decreased from 36 ± 9 on average to 20 ± 8 after surgery, with an average score at the final follow-up of 4 ± 3, similar significant improvement in ODI scores reported by Xu et al [14] in his retrospective study group. in a study by Singh et al [15] , The preop ODI scores decreased from 32.52 on average to 13.42 after surgery, with an average score at the final follow-up of 3.96, The ODI scores in our study decreased from 35.85 (19-62) on average prior to surgery to 21.20 (11-42) after surgery, with an average score at the final follow-up of 8.40 .…”

Standalone Instrumented Posterior Approach Used as Universal Approach for Tuberculosis Spondylodiscitis

“…studied two groups comparing limited decompression laminar reconstruction group with the laminectomy group and have found better Oswestry disability score in the former. [26] However, they urge to limit the indication to monosegmental less kyphotic group and prefer the latter group in multilevel involvement or those with complete paraplegia. Wang et al .…”