Endoscopy-assisted anterior cervical debridement combined with posterior fixation and fusion for the treatment of upper cervical spine tuberculosis: a retrospective feasibility study

Sagittal Parameters and Clinical Outcomes in Cervical Spondylitis: The Cohort Analysis

BACKGROUND

Cervical spondylitis is accompanied by segmental instability and sagittal imbalance. The purpose of this work is to conduct a search of correlation between sagittal parameters and clinical outcomes in cervical spondylitis.

MATERIALS AND METHODS

The monocentric cohort study encompassed the clinical and radiological data of 59 patients who underwent reconstructive surgeries on the suboccipital, subaxial, and cervicothoracic spine. We evaluated local cervical sagittal parameters: cervical sagittal vertical axis (CSVA), T1 slope (T1S), Health-Related Quality of Life-HRQOL (Oswestry Disability Index-ODI)-and others pre- and postoperatively.

RESULTS

The duration of the therapeutic pause and T1S correlated with HRQOL. It revealed the direct relationship between the age of the patient and the value of CSVA. A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more on the Charlson scale.

CONCLUSIONS

The factors influencing HRQOL in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of spondylitis yields a correction of the sagittal balance parameters. The leading predictors of complications from the surgical treatment of cervical spondylitis are the Charlson comorbidity index and the variant of anterior reconstruction.

Case report of minimally invasive spinal endoscopic debridement and pedicle screw fixation for severe spinal infection of the lumbosacral spine

Background

Surgical treatment of spinal infections, refractory to medical treatments, is increasing in incidence. Here, we present a unique case of discitis secondary to an iatrogenic cause, spinal steroid injection, that resulted in acute neurology, ventral phlegmon, and osteomyelitis requiring multiple surgical interventions for treatment.

Case Description

With the adoption of minimally invasive spinal surgery, the patient underwent full endoscopic debridement and decompression at our hospital. The endoscopic technique offers a unique avenue to the anatomically difficult ventral phlegmon for surgical excision, cultures, and pathogen identification. The endoscopic debridement was paired with percutaneous pedicle screw fixation to stabilize the spine from the worsening bone destruction.

Outcome

The patient recovered well postoperatively, with the resolution of her neurological symptoms and improved mobility.

Conclusions

Full endoscopic spinal debridement and decompression is a powerful tool to manage severe spinal discitis and preliminary studies encourage its adoption in surgical practices.

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

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.