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Kaloostian PE, Gokaslan ZL. Current management of spinal tuberculosis: a multimodal approach. World Neurosurg 2013; 80:64-5. [PMID: 23376379 DOI: 10.1016/j.wneu.2013.01.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Paul E Kaloostian
- Department of Neurosurgery, Johns Hopkins University, Baltimore, Maryland, USA.
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Chandra SP, Singh A, Goyal N, Laythalling RK, Singh M, Kale SS, Sharma MS, Suri A, Singh P, Garg A, Sarkar C, Tripathi M, Sharma BS, Mahapatra AK. Analysis of changing paradigms of management in 179 patients with spinal tuberculosis over a 12-year period and proposal of a new management algorithm. World Neurosurg 2013; 80:190-203. [PMID: 23348057 DOI: 10.1016/j.wneu.2012.12.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 08/10/2012] [Accepted: 12/12/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe management and outcome in a large cohort of patients with spinal tuberculosis (TB). METHODS Of 212 patients with spinal TB treated between January 1999 and June 2011, 179 patients were included in the study (≥6 months follow-up; mean age, 34.8 years; age range, 10-75 years). The cohort was divided into two groups (n = 89 and n = 90); group I was treated from 1999-2003, and group II was treated from 2004-2011. RESULTS The study cohort comprised 93 male patients. Mean age was 34.8 years ± 7.2 (range, 10-75 years). Mean duration of symptoms was 2.4 months. Sensorimotor deficits were present in 167 patients (93.5%; 74 patients were paraplegic), pain was present in 156 patients (87%), bladder involvement was present in 127 patients (71.7%), and extraspinal TB was present in 36 patients (22.3%). Of patients, 92% were receiving prior chemotherapy; one fifth of these patients were on second-line chemotherapy. Thoracic spine involvement was most common (n = 86; 57%), followed by cervical spine (n = 50; 29%), craniovertebral junction (n = 22; 15%), and lumbosacral spine (n = 20; 10.5%). Surgery was performed in 146 patients (68% instrumented fusions and 16% circumferential fusions). Mean follow-up was 20.2 months (range, 6-60 months). Sensorimotor deficits improved in 89% of patients, pain improved in 71%, bladder symptoms improved in 88%, and paraplegia improved in 77%. Patients in group II had a higher incidence of cord compression (P < 0.01), severe vertebral body collapse (P < 0.001), and paraplegia (P < 0.001). Group II patients underwent more instrumented surgeries (P < 0.01), especially circumferential fusions (P < 0.001). The improvement in paraplegia was better after 2004 (group II). Bladder symptoms correlated with the timing of surgery (P < 0.1). CONCLUSIONS Medical treatment of spinal TB is the mainstay; however, radical, instrumented surgeries should be offered when indicated. The presence of paraplegia should not preclude surgery. A practical management paradigm is also suggested.
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Affiliation(s)
- Sarat P Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
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Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal tuberculosis: diagnosis and management. Asian Spine J 2012; 6:294-308. [PMID: 23275816 PMCID: PMC3530707 DOI: 10.4184/asj.2012.6.4.294] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2011] [Revised: 12/02/2011] [Accepted: 01/17/2012] [Indexed: 01/11/2023] Open
Abstract
The spinal column is involved in less than 1% of all cases of tuberculosis (TB). Spinal TB is a very dangerous type of skeletal TB as it can be associated with neurologic deficit due to compression of adjacent neural structures and significant spinal deformity. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a narrative review with analysis of all the articles available for us which were published between 1990 and 2011. Althoug h the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.
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Affiliation(s)
- Mohammad R. Rasouli
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orhtopaedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, USA
| | - Maryam Mirkoohi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orhtopaedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, USA
| | - Kourosh Karimi Yarandi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Research Centre for Neural Repair, University of Tehran, Tehran, Iran
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Choo CY, Pan WJ, Lee HC. Spinal tuberculosis as a cause of low back pain--a timely reminder. PAIN MEDICINE 2012; 13:613-4. [PMID: 22390382 DOI: 10.1111/j.1526-4637.2012.01345.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fuentes Ferrer M, Gutiérrez Torres L, Ayala Ramírez O, Rumayor Zarzuelo M, del Prado González N. Tuberculosis of the spine. A systematic review of case series. INTERNATIONAL ORTHOPAEDICS 2012; 36:221-31. [PMID: 22116392 PMCID: PMC3282843 DOI: 10.1007/s00264-011-1414-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Accepted: 11/02/2011] [Indexed: 10/15/2022]
Abstract
PURPOSE The objective of this systematic review was to characterise the methodological issues, as well as clinical, diagnosis, microbiological and treatment characteristics of patients with spinal tuberculosis. METHODS We conducted a systematic review including prospective or retrospective case series written in English, Spanish, French, German and Italian published in the period from January 1980 to March 2011. RESULTS Thirty-seven articles were included with a total of 1,997 patients; the median of the percentage of men was 53% (interquartile range [IQR] 48-64) and the median of the patients mean age was 43.4 (IQR 37-55). The most common symptom reported was back pain, and thoracic spine was the most frequent segment involved. Spinal plain radiography was done in 35 studies (94.6%), magnetic resonance imaging (MRI) in 26 (70.2%), computed tomography scan (CT-scan) in 13 (35%) and microbiological diagnosis in 29 (78.3%). Surgical treatment was reported in 28 articles 75.7%; finally, 24 articles reported follow-up, and in 15 of them at least 80% of patients improved. CONCLUSIONS Spinal TB is still an important public health issue, it must be suspected in the presence of back pain or characteristic images and should be confirmed with microbiological procedures. Chemotherapy treatment is often used; in contrast, there is heterogeneity in the percentage of patients treated by surgery.
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Jain AK, Srivastava A, Saini NS, Dhammi IK, Sreenivasan R, Kumar S. Efficacy of extended DOTS category I chemotherapy in spinal tuberculosis based on MRI-based healed status. Indian J Orthop 2012; 46:633-9. [PMID: 23325964 PMCID: PMC3543879 DOI: 10.4103/0019-5413.104191] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Duration of treatment in tuberculosis of spine has always been debatable in the absence of marker of healing. The objective of the study was to evaluate the efficacy of extended DOTS regimen (2 months of intensive phase and 6 months of continuation phase) as recommended by WHO, by using MRI observations as the healing marker. MATERIALS AND METHODS 51 (Group A -28 prospective and Group B- 23 retrospective) patients of spine TB with mean age of 26.8 years (range 15-54 years) diagnosed clinico radiologically/imaging (n=36), histopathology or by PCR (n=15) were enrolled for the study. They were treated by extended DOTS regimen (2 months of HRZE and 6 months of HR) administered alternate day. The serial blood investigations and X-rays were done every 2 months. Contrast MRI was done at the end of 8 months and healing changes were recorded. Criteria of healing on the basis of MRI being: complete resolution of pre and paravertebral collections, resolution of marrow edema of vertebral body (VB), replacement of marrow edema by fat or by calcification suggested by iso- intense T1 and T2 weighted images in contrast enhanced MRI. Patients with non healed status, but, responding lesion on MRI after 8 months of treatment were continued on INH and rifampicin alternate day and contrast MRI was done subsequently at 12 months and 18 months till the healed status was achieved . RESULTS 9 patients had paraplegia and required surgical intervention out of which 1 did not recover neurologically. All patients have completed 8 months of extended DOTS regimen, n=18 achieved healed status and duration of treatment was extended in rest (n=33) 5 were declared healed after 12 months, 8 after 18 months and one after 36 months of treatment, thus 32 were declared healed at varying periods. CONCLUSION 35.2% patients demonstrate MRI based healed vertebral lesion at the end of 8 months of extended category 1 DOTS regimen. It is unscientific to stop the ATT by fixed time frame and MRI evaluation of the patients is required after 8 months of ATT and subsequently to decide for the continuation stoppage of treatment.
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Affiliation(s)
- Anil K Jain
- Department of Orthopaedics, UCMS and GTB Hospital, Dilshad Garden, Delhi, India,Address for correspondence: Dr. Anil K Jain, Professor of Orthopaedics, University College of Medical, Sciences and GTB Hospital, Delhi, India, Editor, Indian Journal of Orthopaedics E-mail:
| | - Amit Srivastava
- Department of Orthopaedics, UCMS and GTB Hospital, Dilshad Garden, Delhi, India
| | | | - Ish K Dhammi
- Department of Orthopaedics, UCMS and GTB Hospital, Dilshad Garden, Delhi, India
| | - Ravi Sreenivasan
- Department of Orthopaedics, UCMS and GTB Hospital, Dilshad Garden, Delhi, India
| | - Sudhir Kumar
- Department of Orthopaedics, UCMS and GTB Hospital, Dilshad Garden, Delhi, India
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Abstract
Spinal tuberculosis is a destructive form of tuberculosis. It accounts for approximately half of all cases of musculoskeletal tuberculosis. Spinal tuberculosis is more common in children and young adults. The incidence of spinal tuberculosis is increasing in developed nations. Genetic susceptibility to spinal tuberculosis has recently been demonstrated. Characteristically, there is destruction of the intervertebral disk space and the adjacent vertebral bodies, collapse of the spinal elements, and anterior wedging leading to kyphosis and gibbus formation. The thoracic region of vertebral column is most frequently affected. Formation of a 'cold' abscess around the lesion is another characteristic feature. The incidence of multi-level noncontiguous vertebral tuberculosis occurs more frequently than previously recognized. Common clinical manifestations include constitutional symptoms, back pain, spinal tenderness, paraplegia, and spinal deformities. For the diagnosis of spinal tuberculosis magnetic resonance imaging is more sensitive imaging technique than x-ray and more specific than computed tomography. Magnetic resonance imaging frequently demonstrates involvement of the vertebral bodies on either side of the disk, disk destruction, cold abscess, vertebral collapse, and presence of vertebral column deformities. Neuroimaging-guided needle biopsy from the affected site in the center of the vertebral body is the gold standard technique for early histopathological diagnosis. Antituberculous treatment remains the cornerstone of treatment. Surgery may be required in selected cases, e.g. large abscess formation, severe kyphosis, an evolving neurological deficit, or lack of response to medical treatment. With early diagnosis and early treatment, prognosis is generally good.
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Affiliation(s)
- Ravindra Kumar Garg
- Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
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Donald P. The chemotherapy of osteo-articular tuberculosis with recommendations for treatment of children. J Infect 2011; 62:411-39. [DOI: 10.1016/j.jinf.2011.04.239] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Accepted: 04/29/2011] [Indexed: 02/07/2023]
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Su SH, Tsai WC, Lin CY, Lin WR, Chen TC, Lu PL, Huang PM, Tsai JR, Wang YL, Feng MC, Wang TP, Chen YH. Clinical features and outcomes of spinal tuberculosis in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2010; 43:291-300. [PMID: 20688289 DOI: 10.1016/s1684-1182(10)60046-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Revised: 06/30/2009] [Accepted: 07/29/2009] [Indexed: 11/17/2022]
Abstract
BACKGROUND/PURPOSE The early diagnosis and appropriate management of spinal tuberculosis (TB) is challenging for clinicians. This study aimed to characterize the clinical features and factors affecting treatment outcomes. METHODS A retrospective study of patients with spinal TB over a 7-year period at a medical center in southern Taiwan was conducted. Clinical features, underlying diseases, laboratory results, imaging findings, therapy, treatment duration and outcomes were analyzed. RESULTS Forty-eight patients (24 men and 24 women) were diagnosed with spinal TB. Their mean age was 64.3 years. The most common presenting symptoms were backache, neurological deficits, and fever. The most common vertebral area involved was lumbar spine (41.7%). The mean number of vertebra involved was 2.46. Surgery was carried out on 30 patients (62.5%). Patients who had a longer duration of symptoms prior to diagnosis were more likely to have surgery (p = 0.03), and patients who received surgery had a more favorable outcome (p = 0.063). The mean treatment course was 11.4 +/- 3.7 months. A long course treatment did not contribute to favorable outcomes. Twenty-six patients had a favorable outcome and 11 had an unfavorable outcome. Factors associated with an unfavorable outcome included older age, limb weakness, incontinence, spinal kyphotic deformity, and spinal cord compression. CONCLUSION For elderly patients with chronic back pain in Taiwan, the differential diagnosis of spinal TB should be considered. Image studies and computed tomography-guided aspiration are helpful for early detection. Combined surgical intervention tended to have a more favorable outcome and longer treatment periods had no additional benefit.
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Affiliation(s)
- Shou-Hsin Su
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung, Taiwan
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Abstract
The dismal outcome of tuberculosis of the spine in the pre-antibiotic era has improved significantly because of the use of potent antitubercular drugs, modern diagnostic aids and advances in surgical management. MRI allows the diagnosis of a tuberculous lesion, with a sensitivity of 100% and specificity of 88%, well before deformity develops. Neurological deficit and deformity are the worst complications of spinal tuberculosis. Patients treated conservatively show an increase in deformity of about 15 degrees . In children, a kyphosis continues to increase with growth even after the lesion has healed. Tuberculosis of the spine is a medical disease which is not primarily treated surgically, but operation is required to prevent and treat the complications. Panvertebral lesions, therapeutically refractory disease, severe kyphosis, a developing neurological deficit, lack of improvement or deterioration are indications for surgery. Patients who present with a kyphosis of 60 degrees or more, or one which is likely to progress, require anterior decompression, posterior shortening, posterior instrumented stabilisation and anterior and posterior bone grafting in the active stage of the disease. Late-onset paraplegia is best prevented rather than treated. The awareness and suspicion of an atypical presentation of spinal tuberculosis should be high in order to obtain a good outcome. Therapeutically refractory cases of tuberculosis of the spine are increasing in association with the presence of HIV and multidrug-resistant tuberculosis.
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Affiliation(s)
- A K Jain
- University College of Medical Sciences, University of Delhi, Delhi-95, India.
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Abstract
STUDY DESIGN A prospective study on spinal tuberculosis conducted at Fauji Foundation Hospital, Rawalpindi, Pakistan, with 1 year of follow-up. OBJECTIVE The main aim was to diagnose spinal tuberculosis on clinical grounds and with simple noninvasive laboratory and radiology investigations and to treat the patients with antituberculosis drugs. SUMMARY OF BACKGROUND DATA Spinal tuberculosis associated with any neuro deficit is usually treated by surgery. Medical treatment can reverse most of the neuro deficit. Surgery should not be the first choice of treatment. METHODS Twenty-six patients with spinal tuberculosis were clinically diagnosed, were started on antituberculosis treatment, and were followed up for 12 months. RESULTS Backache is the most common symptom. Thirty-eight percent of patients presented with neuro deficit in the form of paraplegia and quadriplegia. Erythrocyte sedimentation rate was high in 100% cases. Plain radiograph diagnosed the disease in 88.27% patients. Eighty-five percent of cases completely improved on medical treatment without any surgical intervention. CONCLUSION Uncomplicated spinal tuberculosis is a medical problem. The study shows that surgical intervention is not always necessary.
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Kim YM, Cha JH. Delayed diagnosis of tuberculous spondylitis masked by concomitant methicillin resistant Staphylococcus aureus infection. J Korean Neurosurg Soc 2010; 47:235-8. [PMID: 20379481 DOI: 10.3340/jkns.2010.47.3.235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Revised: 08/29/2009] [Accepted: 01/12/2010] [Indexed: 12/22/2022] Open
Abstract
We present a case of tuberculous spondylitis in which diagnosis was masked by a concomitant pyogenic infection. The patient had undergone percutaneous needle aspiration of an abscess in the cavity of the psoas muscle. Early results from the culture regimen showed isolation of methicillin-resistant Staphylococcus aureus. After eight weeks, mycobacterium tuberculosis was grown at regimen which was cultured at the same site. Initial isolation of pyogenic bacteria, considered to be highly virulent organisms, led to delayed diagnosis and treatment of the tuberculosis.
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Affiliation(s)
- Yong Min Kim
- Department of Neurosurgery, Maryknoll Medical Center, Busan, Korea
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Ringshausen FC, Tannapfel A, Nicolas V, Weber A, Duchna HW, Schultze-Werninghaus G, Rohde G. A fatal case of spinal tuberculosis mistaken for metastatic lung cancer: recalling ancient Pott's disease. Ann Clin Microbiol Antimicrob 2009; 8:32. [PMID: 19930560 PMCID: PMC2784744 DOI: 10.1186/1476-0711-8-32] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/20/2009] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculous spondylitis (Pott's disease) is an ancient human disease. Because it is rare in high-income, tuberculosis (TB) low incidence countries, misdiagnoses occur as sufficient clinical experience is lacking. Case presentation We describe a fatal case of a patient with spinal TB, who was mistakenly irradiated for suspected metastatic lung cancer of the spine in the presence of a solitary pulmonary nodule of the left upper lobe. Subsequently, the patient progressed to central nervous system TB, and finally, disseminated TB before the accurate diagnosis was established. Isolation and antimycobacterial chemotherapy were initiated after an in-hospital course of approximately three months including numerous health care related contacts and procedures. Conclusion The rapid diagnosis of spinal TB demands a high index of suspicion and expertise regarding the appropriate diagnostic procedures. Due to the devastating consequences of a missed diagnosis, Mycobacterium tuberculosis should be considered early in every case of spondylitis, intraspinal or paravertebral abscess. The presence of certain alarm signals like a prolonged history of progressive back pain, constitutional symptoms or pulmonary nodules on a chest radiograph, particularly in the upper lobes, may guide the clinical suspicion.
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Affiliation(s)
- Felix C Ringshausen
- Department of Medicine III, Pneumology, Allergology and Sleep Medicine, University Hospital Bergmannsheil, Ruhr-University Bochum, Germany.
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Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. ACTA ACUST UNITED AC 2009; 22:257-62. [PMID: 19494745 DOI: 10.1097/bsd.0b013e31818859d0] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective case study. OBJECTIVE We present a retrospective clinical study of 15 patients with lumbar and lumbosacral tuberculosis treated by transforaminal lumbar interbody fusion and posterior instrumentation. The purpose is to determine the clinical efficacy of such surgical treatment for lumbar tuberculosis. SUMMARY OF BACKGROUND DATA The goals of management of tuberculous spondylodiscitis are to eradicate infection and to prevent or treat deformity, instability, and neurologic deficit. Various methods of surgical debridement and fusion have been described for the lumbar spine. However, there have been few reports on the treatment of patients with peridiscal type of lumbar tuberculosis by transforaminal debridement and interbody fusion along with posterior stabilization using pedicle screw fixation. METHODS Our study comprises 9 males and 6 females with an average age of 47 years treated with the above given surgical procedure. All patients had single motion segment involvement. The average follow-up is 41 months. We have evaluated the following parameters: healing of disease, deformity correction and its maintenance, improvement in neurology, fusion of affected segment, and functional outcome. RESULTS The mean preoperative local lordotic angle of -3.7 degrees was corrected surgically to a mean of 5 degrees immediately postoperatively. The mean local lordosis at final follow-up (mean 41 mo, 26 to 69 mo) was 4 degrees. Using the modified radiologic criteria of Lee et al, we found that 13 patients had definitive fusion and 2 patients had probable fusion. All patients had healing of disease and there was no recurrence at final follow-up. Using the criteria of Kirkaldy-Willis et al, the functional outcome was found to be excellent in 8, good in 5, and fair in 2 patients. CONCLUSIONS Transforaminal lumbar interbody fusion with pedicle screw fixation is a simple, safe, and effective procedure for treatment of selected patients suffering from lumbar and lumbosacral tuberculosis.
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Çavuşoğlu H, Kaya RA, Türkmenoğlu ON, Tuncer C, Çolak İ, Aydandinodot;n Y. A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine 2008; 8:30-8. [DOI: 10.3171/spi-08/01/030] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to determine the efficacy of anterior instrumentation following radical debridement and tibial allografting and its long-term progression in patients with multilevel spinal tuberculosis.
Methods
This prospective observational study was undertaken to analyze 22 patients with multilevel spinal tuberculosis (Pott disease) who underwent anterior radical debridement, decompression, and fusion using anterior spinal instrumentation and tibial allograft replacement between 1999 and 2001. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) Impairment Scale and a visual analog scale (VAS). Preoperative and postoperative plain radiographs were obtained, and the focal kyphotic angle of the surgically treated spinal segments and the overall sagittal and coronal contours of the thoracic and lumbar spine were evaluated in all patients.
Results
The mean follow-up time was 84 months (range 36–96 months). All patients demonstrated clinical healing of the tuberculosis infection. All patients showed evidence of successful bone fusion. The mean late postoperative kyphosis correction was 74% (range 63–91%). On average, 2° (range 0–5°) of loss of correction was noted in the local kyphotic angle postoperatively in late follow-up findings. Evaluation of the surgical effect on sagittal global contours showed a significant correction rate in thoracic, thoracolumbar, and lumbar regions. The mean late postoperative coronal plane alignment correction was 99%. The ASIA Impairment Scale scores demonstrated significant improvement in late follow-up results in our series. Surgical decompression also resulted in a dramatic reduction of overall pain in all patients (late postoperative VAS score 1.61 ± 0.81).
Conclusions
Anterior tibial allografting and instrumentation provide correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, and restoration of neurological function in patients with spinal tuberculosis.
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