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Ifthekar S, Ahuja K, Mittal S, Yadav G, Chaturvedi J, Sarkar B, Kandwal P. Outcomes of Dorsolumbar and Lumbar Spinal Tuberculosis Treated by Minimally Invasive and Open Techniques: A Prospective Comparative Study. Indian J Orthop 2024; 58:558-566. [PMID: 38694702 PMCID: PMC11058730 DOI: 10.1007/s43465-024-01123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Purpose of Study To compare the outcomes of minimally invasive and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB). Methods Skeletally mature patients with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included. Healed and mechanically stable STB, patients having severe hepatic and renal impairment, coexisting spinal conditions such as ankylosing spondylitis and rheumatoid arthritis, and patients unwilling to participate were excluded from the study. The patients were divided in to two groups, group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 24 months. Results A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs 742 ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (16° vs 33.25°) was significantly better in group B. Rest of the parameters such as duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups. Conclusion MIS stabilization when compared to open techniques is associated with significant improvement in immediate post-operative VAS scores. The MIS approaches at 2-year follow-up have functional results similar to open techniques. MIS is inferior to open techniques in kyphosis correction and may be associated with complications.
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Affiliation(s)
- Syed Ifthekar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- BLK Max Speciality Hospital, Delhi, India
| | - Gagandeep Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Jiitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
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Arifin J, Biakto KT, Johan MP, Anwar SFZ. Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis. Spine Deform 2024; 12:271-291. [PMID: 37975989 PMCID: PMC10867033 DOI: 10.1007/s43390-023-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Spinal tuberculosis (TB) is a slow-developing disease that often causes cord compression, spinal instability, and deformity. Surgery is generally required in cases of refractory disease, severe kyphosis, neurological deficits, or lack of improvement. However, there is a lack of comprehensive evidence in comparing the efficacy of various surgical approaches. The study aims to provide a clearer understanding of the relative effectiveness of the available surgical modalities in the management of spinal TB. METHODS This review adhered to the PRISMA statement with searching conducted until 11th April 2023. Inclusion criteria included studies involving surgical procedures for spinal tuberculosis, with relevant clinical outcomes reported. Data extraction involved the collection of information on study and population characteristics, interventions used, relevant clinical outcomes, and reported complications. The risk of bias was evaluated using Cochrane's Risk of Bias in Non-randomized Studies tool. RESULTS Searching resulted in 20 cohort studies that analyzed surgical methods for spinal tuberculosis. Eleven studies had low bias and nine studies had moderate bias. The anterior approach was associated with faster perioperative duration [- 2.02 (- 30.71, 26.67), p < 0.00001], less blood loss [- 4242 (- 176.02, 91.18), p < 0.00001], shorter hospitalization [- 0.19 (- 2.39, 2.01), p < 0.00001], better angle correction [1.01 (- 1.82, 3.85), p < 0.00001], and better correction rates [11.36 (- 7.32, 30.04), p < 0.00001] compared to the posterior approach. Regarding neurological function recovery, the anterior and posterior approaches were equally effective, while the posterior approach was associated with a higher incidence of complications. The review also reported on the complications associated with the surgical approaches, and 9 out of 20 studies reported complications. The anterior approach was found to have fewer complications overall. CONCLUSION The anterior approach is thought to have fewer complications than both combined and posterior-only approaches, but the variability of the findings indicates that the decision-making process for selecting a surgical approach must consider individual patient and disease characteristics, as well as surgeon training.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Karya Triko Biakto
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - St Fatimah Zahrah Anwar
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia.
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Ruparel S, Tanaka M, Mehta R, Yamauchi T, Oda Y, Sonawane S, Chaddha R. Surgical Management of Spinal Tuberculosis-The Past, Present, and Future. Diagnostics (Basel) 2022; 12:1307. [PMID: 35741117 PMCID: PMC9221609 DOI: 10.3390/diagnostics12061307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 02/03/2023] Open
Abstract
Tuberculosis is endemic in many parts of the world. With increasing immigration, we can state that it is prevalent throughout the globe. Tuberculosis of the spine is the most common form of bone and joint tuberculosis; the principles of treatment are different; biology, mechanics, and neurology are affected. Management strategies have changed significantly over the years, from watchful observations to aggressive debridement, to selective surgical indications based on well-formed principles. This has been possible due to the development of various diagnostic tests for early detection of the disease, effective anti-tubercular therapy, and associated research, which have revolutionized treatment. This picture is rapidly changing with the advent of minimally invasive spine surgery and its application in treating spinal infections. This review article focuses on the past, present, and future principles of surgical management of tuberculosis of the spine.
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Affiliation(s)
- Sameer Ruparel
- Department of Orthopaedic Surgery, Jaslok Hospital and Research Centre, Mumbai 400026, India;
| | - Masato Tanaka
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (M.T.); (T.Y.); (Y.O.)
| | - Rahul Mehta
- Department of Orthopaedic Surgery, R.D. Gardi Mecial College, Ujjain 456001, India;
| | - Taro Yamauchi
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (M.T.); (T.Y.); (Y.O.)
| | - Yoshiaki Oda
- Department of Orthopaedic Surgery, Okayama Rosai Hospital, Okayama 702-8055, Japan; (M.T.); (T.Y.); (Y.O.)
| | - Sumeet Sonawane
- Department of Orthopaedic Surgery, BKL Walawalkar Medical College, Sawarde 415606, India;
| | - Ram Chaddha
- Department of Orthopaedic Surgery, Jaslok Hospital and Research Centre, Mumbai 400026, India;
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Bajaj J, Yadav YR. History of Endoscopic Spine Surgery in India. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1730872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractEndoscopic spine surgeries provide distinct advantages and is therefore a viable alternative to open or microscopic techniques. Indian surgeons have shown their expertise from craniovertebral junction to lumbosacral spine with these techniques. Many novel approaches like endoscopic transcervical, partial corpectomy, and others have been designed, and many technological innovations for these surgeries have been made. With different training programs attracting both native and international surgeons, the future of endoscopic spine surgery is bright.
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Affiliation(s)
- Jitin Bajaj
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Yad Ram Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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Ahuja K, Gupta T, Ifthekar S, Mittal S, Yadav G, Kandwal P. Variability in Management Practices and Surgical Decision Making in Spinal Tuberculosis: An Expert Survey-Based Study. Asian Spine J 2021; 16:9-19. [PMID: 33789415 PMCID: PMC8874003 DOI: 10.31616/asj.2020.0557] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 12/01/2020] [Indexed: 11/23/2022] Open
Abstract
Study Design Electronic survey–based study. Purpose The aim of the study was to objectively review the variability in the prevailing treatment protocols and surgical decision making in the management of patients with spinal tuberculosis (TB) among spine surgeons with expertise in spinal TB across the country. Overview of Literature A lack of good-quality evidence, ambiguities in the national spinal TB guidelines, and the demand for early rehabilitation and a better quality of life in patients with spinal TB has led to the emergence of various gray zones in the management of spinal TB. Methods Seventeen fellowship-trained spinal TB experts representing different geographical regions of India completed an online survey consisting of questions pertaining to the conservative management of spinal TB (antitubercular therapy) and 30 clinical case vignettes including a wide spectrum of presentations of spinal TB with no or minimal neurological deficit. The variability in the responses for questions and case wise variability with respect to surgical decision making was assessed using the index of qualitative variation (IQV). The average tendency to operate (TTO) was calculated for various groups of respondents. Results High variability was observed in all questions regarding conservative spinal TB management (IQV > 0.8). Among the 30 case vignettes, 14 were found to have high variability with respect to surgical decision making (IQV > 0.8). With respect to levels of fixation, all but two cases had poor or slight agreement. Younger age and practice in a government or tertiary care teaching hospital were factors associated with a higher TTO. Conclusions Significant variability was detected in treatment practices for the management of spinal TB among experts. Most of the case vignettes were found to have significant heterogeneity with respect to surgical decision making, which reflects a significant lack of consensus and lacunae in literature.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Tushar Gupta
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Syed Ifthekar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Samarth Mittal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Gagandeep Yadav
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, India
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Chilkoti GT, Jain N, Mohta M, Saxena AK. Perioperative concerns in Pott's spine: A review. J Anaesthesiol Clin Pharmacol 2021; 36:443-449. [PMID: 33840921 PMCID: PMC8022046 DOI: 10.4103/joacp.joacp_167_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/29/2019] [Accepted: 03/06/2020] [Indexed: 11/10/2022] Open
Abstract
Pott's disease is the most common granulomatous spine infection caused by tubercle bacilli and is a common site of osseous tuberculosis, accounting for 50–60% of cases. The delay in establishing diagnosis and management results in complications such as spinal cord compression and spinal deformity. The aim of this narrative review is to discuss the perioperative concerns in patients for spine surgery. The literature source for this review was obtained via PubMed, Medline, Google Scholar, Cochrane database of systematic reviews, and textbooks until December 2019. On the literature search, we could not retrieve any review article specifically discussing the perioperative concerns of spinal tuberculosis. Therefore, the aim of the present narrative review is to discuss the perioperative concerns of patients for spine surgery along with the specific concerns related to spinal tuberculosis.
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Affiliation(s)
- Geetanjali Tolia Chilkoti
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Nidhi Jain
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Medha Mohta
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
| | - Ashok K Saxena
- Department of Anesthesiology and Critical Care, University College of Medical Sciences and Guru Teg Bahadur Hospital, Shahdara, Delhi, India
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Stienen MN, Sprengel K, Butsch R, Achermann Y, Wolfensberger A, Regli L, Bellut D. [Tuberculous Spondylitis - Diagnosis and Management]. PRAXIS 2020; 109:775-787. [PMID: 32752962 DOI: 10.1024/1661-8157/a003518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tuberculous Spondylitis - Diagnosis and Management Abstract. Despite a decreasing incidence of tuberculosis (TB) over the last decades in Switzerland, the frequency of newly diagnosed tuberculous spondylitis has remained stable. It occurs most frequently in old, immunocompromised persons and/or persons who have moved to Switzerland from TB endemic areas. It is a chronic manifestation of TB, which is characterized by 'cold abscesses', neurological deficits and kyphotic spinal deformity. Tuberculous spondylitis is often diagnosed with a delay, which can lead to higher morbidity and treatment complexity. Antibiotic therapy is essential in tuberculous spondylitis. Surgical interventions aim to obtain samples, decompress nervous structures, obtain pain control and, if necessary, deformity correction/stabilization. This paper provides an overview of the modern diagnostic and therapeutic management of tuberculous spondylitis in Switzerland.
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Affiliation(s)
- Martin N Stienen
- Interdisziplinäres Wirbelsäulenzentrum, Universitätsspital Zürich, Universität Zürich
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich
- Klinisches Neurozentrum, Universität Zürich
| | - Kai Sprengel
- Interdisziplinäres Wirbelsäulenzentrum, Universitätsspital Zürich, Universität Zürich
- Klinik für Traumatologie, Universitätsspital Zürich, Universität Zürich
| | - Raphael Butsch
- Interdisziplinäres Wirbelsäulenzentrum, Universitätsspital Zürich, Universität Zürich
- Klinik für Rheumatologie, Universitätsspital Zürich, Universität Zürich
| | - Yvonne Achermann
- Klinik für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Universität Zürich
| | - Aline Wolfensberger
- Klinik für Infektionskrankheiten und Spitalhygiene, Universitätsspital Zürich, Universität Zürich
| | - Luca Regli
- Interdisziplinäres Wirbelsäulenzentrum, Universitätsspital Zürich, Universität Zürich
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich
- Klinisches Neurozentrum, Universität Zürich
| | - David Bellut
- Interdisziplinäres Wirbelsäulenzentrum, Universitätsspital Zürich, Universität Zürich
- Klinik für Neurochirurgie, Universitätsspital Zürich, Universität Zürich
- Klinisches Neurozentrum, Universität Zürich
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Kunakornsawat S, Philawuth N, Piyaskulkaew C, Pruttikul P, Pluemvitayaporn T, Kittithamvongs P. Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis. Asian Spine J 2019; 13:984-991. [PMID: 31352728 PMCID: PMC6894970 DOI: 10.31616/asj.2018.0200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 02/25/2019] [Indexed: 12/04/2022] Open
Abstract
Study Design Retrospective cohort. Purpose To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments. Overview of Literature The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach. Methods The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients. Results The patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference. Conclusions Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.
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Affiliation(s)
- Sombat Kunakornsawat
- Center of Excellence in Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
| | - Nattaphon Philawuth
- Center of Excellence in Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
| | - Chaiwat Piyaskulkaew
- Center of Excellence in Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
| | - Pritsanai Pruttikul
- Center of Excellence in Orthopaedics, Lerdsin General Hospital, Bangkok, Thailand
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Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J 2019; 19:1858-1870. [PMID: 31102727 DOI: 10.1016/j.spinee.2019.05.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 02/03/2023]
Abstract
Nearly one-third of the human population is infected with tuberculosis. Of those with active disease, approximately 10% are impacted by skeletal tuberculosis. Though, traditionally a disease of the developing world and susceptible populations, with the rise of immigration, patients may present in developed countries. The microbe responsible is the mycobacterium tuberculosis complex bacillus. The infection begins in the anterior vertebral bodies. The natural history and presentation are notable for cold abscesses causing mass effect, early or late neurological deficit, and kyphotic deformity of the spine caused by anterior vertebral body destruction. The disease can be diagnosed with laboratory studies and characteristic imaging findings, but tissue diagnosis with cultures, histology, and polymerase chain reaction is the gold standard. The cornerstone of medical management is multidrug chemotherapy to minimize relapse and drug resistance, and can be curative for spinal tuberculosis with minimal residual kyphosis. Surgical management is reserved for patients presenting with neurological deficits or severe kyphosis. The mainstays of surgical management are debridement, correction of spinal deformity and stable fusion. With appropriate and timely management, clinical outcomes of the treatment of spinal tuberculosis are overall excellent.
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A unilateral less invasive posterolateral approach for disc debridement and titanium cage insertion supplemented by contralateral transfascial screw fixation for high-morbidity patients suffering from septic thoracolumbosacral spondylodiscitis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1187-1197. [PMID: 30993521 DOI: 10.1007/s00590-019-02434-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 04/02/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE This case series reports on the efficacy and safety of a less invasive posterolateral approach for septic thoracolumbosacral spondylodiscitis in high-morbidity patients. METHODS Twenty consecutive severe sick (ASA > III) patients (14 men and 6 women), with an average age of 64 ± 14 years, suffering from septic subacute and chronic thoracolumbosacral spondylodiscitis were selected to undergo a one-stage less invasive unilateral posterolateral disc space debridement, supplemented by an ipsilateral titanium cage implantation and pedicle screw fixation plus a contralateral transfascial pedicle screw fixation. RESULTS Two high-risk patients with severe comorbidities (ASA stage IV and V, respectively) died on days 1 and 8 postoperatively because of non-surgical complications such as massive lung embolism and acute myocardial infract, respectively. Three patients with incomplete paraplegia (ASIA C) preoperatively were improved after the surgery to ASIA D (two patients) and E (one patient), respectively, while there was no neurological deterioration in any patient postoperatively. From the 18 patients that survived, ten patients were available for the final follow-up 8.8 ± 2.7 years postoperatively. In two patients with spondylodiscitis caused by gram(-) bacteria, the posterior instrumentation was finally removed because of asymptomatic fistula emerging from posterior instrumentation solely, 15 and 19 months after surgery. The survivals at 2.5 and 10 years with revision as end point was 87.4% (95% CI 58.1-96.7); while in the "worst case scenario" the survivals at 2.5 and 10 years were: 66.7% (95% CI 40.4-83.4%); 47.7% (95% CI 23.2-68.8%) and 47.7% (95% CI 23.2-68.8%), respectively. CONCLUSIONS The less invasive posterolateral approach for disc debridement and titanium cage insertion seems to be an alternative surgery for severe sick adult immunosuppressed patients with septic thoracolumbosacral spondylodiscitis that cannot tolerate traditional open transthoracic, thoracolumbar, retroperitoneal or combined approaches. The study has been registered in the Public Registry ClinicalTrials.gov PRS with the ID: NCT03472131.
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Abstract
STUDY DESIGN Review article. OBJECTIVES A review of literature on the epidemiology, diagnosis, and management of spinal tuberculosis (TB). METHODS A systematic computerized literature search was performed using Cochrane Database of Systematic Reviews, EMBASE, and PubMed. Studies published over the past 10 years were analyzed. The searches were performed using Medical Subject Headings terms, and the subheadings used were "spinal tuberculosis," "diagnosis," "epidemiology," "etiology," "management," "surgery," and "therapy." RESULTS Tissue diagnosis remains the only foolproof investigation to confirm diagnosis. Magnetic resonance imaging and Gene Xpert help in early detection and treatment of spinal TB. Uncomplicated spinal TB has good response to appropriately dosed multimodal ambulant chemotherapy. Surgery is warranted only in cases of neurological complications, incapacitating deformity, and instability. CONCLUSIONS The incidence of atypical clinicoradiological presentations of spinal TB is on the rise. Improper dosing, inadequate duration of treatment, and inappropriate selection of candidates for chemotherapy has not only resulted in the resurgence of TB but also led to the most dreadful consequence of multidrug resistant strains. In addition, global migration phenomenon has resulted in worldwide spread of spinal TB. The current consensus is to diagnose and treat spinal TB early, prevent complications, promote early mobilization, and restore the patient to his or her earlier functional status.
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Affiliation(s)
- S. Rajasekaran
- Ganga Hospital, Coimbatore, India,S. Rajasekaran, Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore 641043, India.
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Shetty A, Kanna RM, Rajasekaran S. TB spine—Current aspects on clinical presentation, diagnosis, and management options. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.semss.2015.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Yang H, Hou K, Zhang L, Zhang X, Wang Y, Huang P, Xiao S. Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients. J Clin Neurosci 2016; 32:9-13. [PMID: 27506780 DOI: 10.1016/j.jocn.2015.11.036] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 11/03/2015] [Accepted: 11/08/2015] [Indexed: 11/19/2022]
Abstract
The aim of this study was to evaluate the efficacy of minimally invasive spinal decompression combined with local chemotherapy in treating patients with thoracic/lumbar tuberculosis (TB) and abscess compression of the spinal canal. Clinical data of 31 patients with thoracic/lumbar TB and spinal epidural abscess, admitted to our hospital between December 2005 and June 2014 were retrospectively analyzed. All patients received initial conservative treatment but achieved unsatisfactory results and then underwent minimally invasive spinal canal decompression, focus debridement and catheter drainage through a posterior interlaminar approach. Postoperatively, a short-course (1-2months) of local chemotherapy was given. The patients were followed up on a regular basis. The neurologic status was graded according to the American Spinal Injury Association (ASIA) score system. Kyphotic deformity was evaluated using Cobb angle measurement. Patients were followed up for an average of 37months (range: 12-96months). At the last follow-up, ASIA scores were improved in all patients, and there was a mild increase in the Cobb angle, but satisfactory spinal stabilization was achieved. Hepatorenal function, erythrocyte sedimentation rate and C-reactive protein levels all returned to normal. One complication was observed, where the patient had worsened deficit postoperatively but achieved a satisfactory recovery (from Grade C to Grade E) one year after a second surgery. Minimally invasive spinal canal decompression combined with local chemotherapy appears to be an effective treatment for patients with thoracic/lumbar TB and abscess compression in the spinal canal.
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Affiliation(s)
- Huadong Yang
- Department of Orthopedics, Beijing Tsinghua Changgung Hospital & Medical Center, Tsinghua University. Beijing 102218, China
| | - Kedong Hou
- Department of Orthopedics, Pinggu Hospital of Capital Medical University, Pinggu, Beijing 101200, China
| | - Lin Zhang
- Department of Orthopedics, PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Xifeng Zhang
- Department of Orthopedics, PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing 100853, China.
| | - Yan Wang
- Department of Orthopedics, PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Peng Huang
- Department of Orthopedics, PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing 100853, China
| | - Songhua Xiao
- Department of Orthopedics, PLA General Hospital, No.28 Fuxing Road, Haidian District, Beijing 100853, China
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Kandwal P, G. V, Jayaswal A. Management of Tuberculous Infection of the Spine. Asian Spine J 2016; 10:792-800. [PMID: 27559464 PMCID: PMC4995267 DOI: 10.4184/asj.2016.10.4.792] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 11/01/2015] [Indexed: 01/22/2023] Open
Abstract
Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. It is primarily a medical disease and treatment consists of a multidrug regimen for 9-12 months. Surgery is reserved for select cases of progressive deformity or where neurological deficit is not improved by anti-tubercular treatment. Technology refinements and improved surgical expertise have improved the operative treatment of spinal tuberculosis. The infected spine can be approached anteriorly or posteriorly, in a minimally invasive way. We review the various surgical techniques used in the management of spinal tuberculosis with focus on their indications and contraindications.
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Affiliation(s)
- Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
| | - Vijayaraghavan G.
- Department of Orthopaedics, Primus Superspeciality Hospital, New Delhi, India
| | - Arvind Jayaswal
- Department of Orthopaedics, Primus Superspeciality Hospital, New Delhi, India
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Zhong W, Xiong G, Wang B, Lu C, Dai Z, Lv G. Surgical management for thoracic spinal tuberculosis posterior only versus anterior video-assisted thoracoscopic surgery. PLoS One 2015; 10:e0119759. [PMID: 25781165 PMCID: PMC4364357 DOI: 10.1371/journal.pone.0119759] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 01/15/2015] [Indexed: 11/19/2022] Open
Abstract
STUDY DESIGN A comparable retrospective study. OBJECT To compare the clinical outcomes of surgical treatment by posterior only and anterior video-assisted thoracoscopic surgery for thoracic spinal tuberculosis (TSTB). METHOD 145 patients with TSTB treated by two different surgical procedures in our institution from June 2001 to June 2014 were studied. All cases were retrospectively analyzed and divided into two groups according to the given treatments: 75 cases (32F/43M) in group A performed single-stage posterior debridement, transforaminal thoracic interbody fusion and instrumentation, and 70 cases (30F/40M) in group B underwent anterior video-assisted thoracoscopic surgery (VATS). Clinical and radiographic results in the two groups were analyzed and compared. RESULTS Patients in group A and B were followed up for an average of 4.6±1.8, 4.4±1.2 years, respectively. There was no statistically significant difference between groups in terms of the operation time, blood loss, bony fusion, neurological recovery and the correction angle of kyphotic deformity (P>0.05). Fewer pulmonary complications were observed in group A. Good clinical outcomes were achieved in both groups. CONCLUSIONS Both the anterior VATS and posterior approaches can effectively treat thoracic tuberculosis. Nevertheless, the posterior approach procedure obtained less morbidity and complications than the other.
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Affiliation(s)
- Weiye Zhong
- Department of Spinal Surgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
| | - Guangzhong Xiong
- Department of Neurosurgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
| | - Bing Wang
- Department of Spinal Surgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
| | - Chang Lu
- Department of Spinal Surgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
- * E-mail: (CL); (GL)
| | - Zhihui Dai
- Department of Spinal Surgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
| | - Guohua Lv
- Department of Spinal Surgery, Second Xiangya Hospital and Central South University, Changsha, Hunan, P.R. China
- * E-mail: (CL); (GL)
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Garg N, Vohra R. Minimally invasive surgical approaches in the management of tuberculosis of the thoracic and lumbar spine. Clin Orthop Relat Res 2014; 472:1855-67. [PMID: 24474323 PMCID: PMC4016460 DOI: 10.1007/s11999-014-3472-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Spinal tuberculosis is the most common form of skeletal tuberculosis. Various approaches have been described for surgical management of spinal tuberculosis, but many entail wide exposures with attendant morbidity; whether minimally invasive surgical (MIS) approaches are suitable is unknown. QUESTIONS/PURPOSES We evaluated (1) neurologic results, (2) radiographic results, and (3) complications in patients with thoracic and lumbar spinal tuberculosis treated with two MIS approaches. METHODS We retrospectively evaluated 22 patients with thoracic and lumbar tuberculosis managed surgically from October 2008 to February 2011 using MIS methods; one patient was lost to followup, leaving 21 patients with a minimum followup of 15 months (mean, 30 months; range, 15-59 months) for analysis. MIS approaches were used for patients with disease below D6 and minimum pedicle diameters of 4.5 mm to permit percutaneous screw placement. The MIS approach was divided into two groups depending on the extent of destruction of the vertebral body: a posterior-only group (n = 9), where posterior transpedicular decompression sufficed, and the hybrid group (n = 12), requiring anterior débridement and ventral-column reconstruction by conventional or mini-open thoracotomy. All but two patients with more than two contiguous bodies involvement underwent MIS posterior fixation by percutaneous transpedicular screws. Plain radiographs were evaluated for deformity correction and correction maintenance. Neurologic recovery and complications were ascertained by chart review. RESULTS All patients with neurologic deficits recovered completely with no motor deficits at followup; 13% improved by three grades, 53% by two grades, and 33% by one grade. Mean correction was 2.5° (thoracic) and 8° (lumbar) in the posterior-only group and 4.2° in the hybrid group. Some correction loss occurred with healing (2° and 1.6° in the posterior-only and hybrid groups, respectively), but in none of those who had fixation did this progress to more than preoperative status. Two of 22 patients (9%) had complications. One had a malposition of L5 screw causing painful radiculopathy without motor deficit and required repositioning. The other had an intraoperative dural tear repaired by onlay fascial patch and cerebrospinal fluid diversion. There were no approach-related complications, neurologic deterioration, or implant fatigue at last followup. CONCLUSIONS We found evidence of neurologic recovery, avoidance of deformity progression, and few complications with these MIS approaches. Comparative trials are called for between open and MIS approaches for patients with spinal tuberculosis. LEVEL OF EVIDENCE Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nitin Garg
- />Department of Neurosurgery, Bhopal Memorial Hospital and Research Centre, Near Karond Square, Bhopal, 462038 India
| | - Renuka Vohra
- />Department of Radiodiagnosis, Bhopal Memorial Hospital and Research Centre, Near Karond Square, Bhopal, 462038 India
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Video-assisted thoracic surgery for tubercular spondylitis. Minim Invasive Surg 2014; 2014:963497. [PMID: 24804092 PMCID: PMC3997134 DOI: 10.1155/2014/963497] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
The present study evaluated the outcome of video-assisted thoracic surgery (VATS) in 9 patients (males = 6, females = 3) with clinico-radiological diagnosis of tubercular spondylitis of the dorsal spine. The mean duration of surgery was 140.88 ± 20.09 minutes, mean blood was 417.77 ± 190.90 mL, and mean duration of postoperative hospital stay was 5.77 ± 0.97 days, Seven patients had a preoperative Grade A neurological involvement, while at the time of final followup the only deficit was Grade D power in 2 patients. In patients without bone graft placement (n = 6), average increase in Kyphosis angle was 16°, while in patients with bone graft placement (n = 3) the deformity remained stationary. At the time of final follow up, fusion was achieved in all patients, the VAS score for back pain improved from a pretreatment score of 8.3 to 2, and the function assessment yielded excellent (n = 4) to good (n = 5) results. In two patients minithoracotomy had to be resorted due to extensive pleural adhesions (n = 1) or difficulty in placement of graft (n = 1). Videoassisted thoracoscopic surgery provides a safe and effective approach in the management of spinal tuberculosis. It has the advantages of decreased blood loss and post operative morbidity with minimal complications.
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Verdú-López F, Beisse R. [Current status of thoracoscopic surgery for thoracic and lumbar spine. Part 2: treatment of the thoracic disc hernia, spinal deformities, spinal tumors, infections and miscellaneous]. Neurocirugia (Astur) 2014; 25:62-72. [PMID: 24456908 DOI: 10.1016/j.neucir.2013.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 02/12/2013] [Accepted: 02/13/2013] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Thoracoscopic surgery or video-assisted thoracic surgery (VATS) of the thoracic and lumbar spine has evolved greatly since it appeared less than 20 years ago. It is currently used in a large number of processes and injuries. The aim of this article, in its two parts, is to review the current status of VATS of the thoracic and lumbar spine in its entire spectrum. DEVELOPMENT After reviewing the current literature, we developed each of the large groups of indications where VATS takes place, one by one. This second part reviews and discusses the management, treatment and specific thoracoscopic technique in thoracic disc herniation, spinal deformities, tumour pathology, infections of the spine and other possible indications for VATS. CONCLUSIONS Thoracoscopic surgery is in many cases an alternative to conventional open surgery. The transdiaphragmatic approach has made endoscopic treatment of many thoracolumbar junction processes possible, thus widening the spectrum of therapeutic indications. These include the treatment of spinal deformities, spinal tumours, infections and other pathological processes, as well as the reconstruction of injured spinal segments and decompression of the spinal canal if lesion placement is favourable to antero-lateral approach. Good clinical results of thoracoscopic surgery are supported by growing experience reflected in a large number of articles. The degree of complications in thoracoscopic surgery is comparable to open surgery, with benefits in regard to morbidity of the approach and subsequent patient recovery.
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Affiliation(s)
| | - Rudolf Beisse
- Wirbelsäulenzentrum Starnberger See Benedictus Krankenhaus, Tutzing, Alemania
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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: 136] [Impact Index Per Article: 11.3] [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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Thoracoscopic maneuvers for chest wall resection and reconstruction. J Thorac Cardiovasc Surg 2012; 144:S52-7. [DOI: 10.1016/j.jtcvs.2012.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 03/31/2012] [Accepted: 06/05/2012] [Indexed: 11/19/2022]
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Kandwal P, Garg B, Upendra BN, Chowdhury B, Jayaswal A. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop 2012; 46:159-64. [PMID: 22448053 PMCID: PMC3308656 DOI: 10.4103/0019-5413.93680] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [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
INTRODUCTION With the advancement of instrumentation and minimally access techniques in the field of spine surgery, good surgical decompression and instrumentation can be done for tuberculous spondylitis with known advantage of MIS (minimally invasive surgery). The aim of this study was to assess the outcome of the minimally invasive techniques in the surgical treatment of patients with tuberculous spondylodiscitis. MATERIALS AND METHODS 23 patients (Group A) with a mean age 38.2 years with single-level spondylodiscitis between T4-T11 treated with video-assisted thoracoscopic surgery (VATS) involving anterior debridement and fusion and 15 patients (Group B) with a mean age of 32.5 years who underwent minimally invasive posterior pedicle screw instrumentation and mini open posterolateral debridement and fusion were included in study. The study was conducted from Mar 2003 to Dec 2009 duration. The indication of surgery was progressive neurological deficit and/or instability. The patients were evaluated for blood loss, duration of surgery, VAS scores, improvement in kyphosis, and fusion status. Improvement in neurology was documented and functional outcome was judged by oswestry disability index (ODI). RESULTS The mean blood loss in Group A (VATS category) was 780 ml (330-1180 ml) and the operative time averaged was 228 min (102-330 min). The average preoperative kyphosis in Group A was 38° which was corrected to 30°. Twenty-two patients who underwent VATS had good fusion (Grade I and Grade II) with failure of fusion in one. Complications occurred in seven patients who underwent VATS. The mean blood loss was 625 ml (350-800 ml) with an average duration of surgery of 255 min (180-345 min) in the percutaneous posterior instrumentation group (Group B). The average preoperative segmental (kyphosis) Cobb's angle of three patients with thoracic TB in Group B was 41.25° (28-48°), improved to 14.5°(11°- 21°) in the immediate postoperative period (71.8% correction). The average preoperative segmental kyphosis in another 12 patients in Group B with lumbar tuberculosis of 20.25° improved to -12.08° of lordosis with 32.33° average correction of deformity. Good fusion (Grade I and Grade II) was achieved in 14 patients and Grade III fusion in 1 patient in Group B. One patient suffered with pseudoarthrosis/doubtful fusion with screw loosening in the percutaneous group. CONCLUSION Good fusion rate with encouraging functional results can be obtained in caries spine with minimally invasive techniques with all the major advantages of a minimally invasive procedures including reduction in approach-related morbidity.
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Affiliation(s)
| | - Bhavuk Garg
- Department of Orthopaedics, AIIMS, New Delhi, India
| | - BN Upendra
- Department of Orthopaedics, AIIMS, New Delhi, India
| | | | - A Jayaswal
- Department of Orthopaedics, AIIMS, New Delhi, India
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Lü G, Wang B, Li J, Liu W, Cheng I. Anterior debridement and reconstruction via thoracoscopy-assisted mini-open approach for the treatment of thoracic spinal tuberculosis: minimum 5-year follow-up. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2011; 21:463-9. [PMID: 21997276 DOI: 10.1007/s00586-011-2038-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2011] [Revised: 08/15/2011] [Accepted: 10/04/2011] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Video-assisted thoracoscopic surgery (VATS) has been developed for surgical treatment of thoracic spinal tuberculosis to overcome the problems associated with a formal thoracotomy. VATS, however, is technically demanding with a difficult learning curve. MATERIALS AND METHODS We conducted a retrospective long-term follow-up study of anterior debridement and reconstruction via a thoracoscopy-assisted mini-open approach for the surgical treatment of thoracic spinal tuberculosis. There were 50 patients collected with mean age 38.3 years with thoracic spinal tuberculosis. RESULTS The average operative time was 210 min (range 170-300 min), the average blood loss during operation was 550 ml (range 300-1,000 ml), and the mean chest drainage duration was 3.5 days (3-5 days). Complications occurred in 17 patients (34%). The mean follow-up was 6.5 years. There was statistically difference in VAS 3 months after surgery compared to preoperatively (P<0.001), as well as final follow-up compared to 3 months post-op (P<0.001). In patients with minor pulmonary impairment as measured by pulmonary function testing, 15 improved to normal and 5 had no change. In patients with moderate pulmonary impairment, 6 improved to normal and 2 improved to minor impairment at final follow-up. Neurological improvement of one to three grades had occurred in 26 patients by final follow-up. There was statistically difference in kyphotic angle 3 months after surgery compared to preoperatively (P<0.05), as well as final follow-up compared to 3 months post-op (P<0.001). The average correction rate of kyphotic angle was 38.7% and the loss of correction rate was 1.3% at final follow-up. No recurrent tuberculosis was found. CONCLUSION Thoracoscopy-assisted mini-open approach can provide a simple, safe, and practical treatment option with minimal invasiveness in cases of thoracic spinal tuberculosis. Successful clinical and radiographic outcomes can be achieved via anterior debridement and reconstruction at long-term follow-up.
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Affiliation(s)
- Guohua Lü
- Department of Spine Surgery, Second Xiangya Hospital of Central South University, Changsha, 410011, China
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Lv GH, Wang B, Li J, Liu WD, Yin GH, Ma ZM. Thoracoscopy-assisted mini-open surgery for anterior column reconstruction in thoracic spinal tuberculosis. Orthop Surg 2009; 1:293-9. [PMID: 22009878 DOI: 10.1111/j.1757-7861.2009.00043.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the clinical effects of thoracoscopy-assisted mini-open surgery for anterior column reconstruction in thoracic spinal tuberculosis. METHODS Fifty-eight patients, 35 men and 23 women, aged 39.2 (range, 19-60) years with thoracic spinal tuberculosis with an average kyphotic angle of 29.2° (range, 18°-42°) underwent thoracoscopy-assisted mini-open surgeries, including thorough debridement and anterior spinal reconstruction. According to the Frankel Grading system, preoperative neurological function was judged as Grade B in 3 cases, Grade C in 7, Grade D in 28, and Grade E in 20. All patients were followed up for an average of 4.6 years. Outcomes were evaluated retrospectively. RESULTS Surgery was accomplished successfully in all cases. The average operation time was 230 min (range, 180-320 min), the average intraoperative blood loss 570 ml (range, 350-1200 ml), and the mean drainage duration 3.6 days (3-5 days). Complications occurred in 19 patients (32.8%). Neurological improvement of one to three grades had occurred in 29 patients by final follow-up. The average correction rate of the kyphotic angle was 36.4%, and no obvious correction loss was detected during follow-up. No recurrent tuberculosis was found in the group. CONCLUSIONS Thoracoscopy-assisted mini-open surgery provides a simple, safe, effective, and practical technology with minimal invasiveness for the treatment of thoracic spinal tuberculosis.
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Affiliation(s)
- Guo-hua Lv
- Department of Spinal Surgery, Second Xiangya Hospital of Central South University, Changsha, China
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Liu YL, Hao YJ, Li T, Song YM, Wang LM. Trans-upper-sternal approach to the cervicothoracic junction. Clin Orthop Relat Res 2009; 467:2018-24. [PMID: 18752031 PMCID: PMC2706332 DOI: 10.1007/s11999-008-0469-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Accepted: 08/06/2008] [Indexed: 02/05/2023]
Abstract
UNLABELLED From August 1999 to February 2006, 11 patients with cervicothoracic lesions (eight males, three females; age range, 17-77 years) were surgically treated using the trans-upper-sternal approach. Combined cervicothoracic incision and upper sternotomy facilitated exposure for tumor resection, partial or subtotal removal of the involved vertebrae, and spinal cord decompression. The spinal column then was stabilized. Neurologic status was assessed using the Frankel classification. Followup for a minimum of 10 months (mean, 31 months; range, 10-56 months) revealed one patient had a chyle leak (50 mL) 1 day after surgery, which resolved after 2 days of drainage. One patient had a transient vocal cord paresis, which recovered within 3 months of surgery. All the patients had improved neurologic function. No nonunions or instrument-related complications developed. Stability of the vertebral column was maintained during followup in all patients. The trans-upper-sternal approach can provide excellent exposure for reconstruction of the cervicothoracic junction. Special care must be taken to avoid injury to the recurrent laryngeal nerve and the thoracic duct. LEVEL OF EVIDENCE Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Yi-Lin Liu
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan 610041 China
| | - Ying-Jie Hao
- Department of Orthopedic Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
| | - Tao Li
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan 610041 China
| | - Yue-Ming Song
- Department of Orthopedic Surgery, West China Hospital, Sichuan University, No. 37 GuoXue Road, Chengdu, Sichuan 610041 China
| | - Li-Min Wang
- Department of Orthopedic Surgery, the First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
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Brand RA. Pathways tracked by dorsolumbar tuberculous abscesses. Clin Orthop Relat Res 2007; 460:276-7. [PMID: 17620817 DOI: 10.1097/01.blo.0000279387.18961.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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