A prospective study comparing three different all-posterior surgical techniques in the management of thoracolumbar spinal tuberculosis

Kalanjiyam, Guna Pratheep; Raja, S Dilip Chand; Rajasekaran, Shanmuganathan; Shetty, Ajoy Prasad; Kanna, Rishi Mugesh

doi:10.1016/j.jcot.2022.102026

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…Though the kyphosis correction achieved was significantly higher in the group who underwent anterior cage reconstruction, the surgical duration, blood loss, and hospital stay were significantly higher in this group. The study showed that there was no difference in the loss of correction, neurological and functional outcomes between the 3 groups, with the posterior column shortening patients having the advantages of shorter surgical duration, hospital stay, and blood loss [75] .…”

Section: Global Reconstruction By Posterior Approachmentioning

confidence: 88%

Active tuberculosis of spine: Current updates

Shanmuganathan,

Ramachandran,

Shetty

et al. 2023

North American Spine Society Journal (NASSJ)

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Section: Global Reconstruction By Posterior Approachmentioning

confidence: 88%

Active tuberculosis of spine: Current updates

Shanmuganathan,

Ramachandran,

Shetty

et al. 2023

North American Spine Society Journal (NASSJ)

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“…In contrast to a single incision in an anterior approach, anterior–posterior approach require an additional incision, increasing bleeding. Additionally, the position change during surgery or staged manner increases the patient’s duration and risks 23 , 24 .…”

Section: Discussionmentioning

confidence: 99%

Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case–control study with a minimum 10-year follow-up

Liu,

He,

Fan

et al. 2024

International Journal of Surgery

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Objective: To evaluate the long-term clinical efficacy of three different surgical approaches in treating thoracolumbar tuberculosis. Methods: A total of 176 patients with thoracolumbar tuberculosis, treated with open surgery at two hospitals, were retrospectively analyzed. Patients were stratified into three groups based on the surgical approach: anterior-only (AO), posterior-only (PO), and anterior–posterior combined (AP) approaches. Collected data encompassed operative duration, intraoperative blood loss, hospital stay length, complications, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) classification, and radiographic measurements of segmental lordotic Cobb angles, correction angles, and correction rates. Results: The minimum duration of follow-up among all patients was 10 years. Postoperatively, all patients experienced a reduction in ESR and CRP, with normalization occurring within 3 months and sustained normal at the last follow-up. The AP group had a longer operative duration and higher intraoperative blood loss than the other two groups. The Cobb correction rates for AO, PO, and AP were (56.33±6.62)%, (72.82±5.66)%, and (74.45±5.78)%, respectively. The correction loss of Cobb angles for AO, PO, and AP were (2.85±1.01)°, (1.42±0.97)°, and (1.19±0.89)°, respectively. Patients in all groups showed significant improvement in VAS scores and ODI postoperatively, with no notable intergroup differences. The neurological recovery rates for the AO, PO, and AP groups were 84.62, 87.10, and 83.72%, respectively, while the complication rates were 12.73, 16.98, and 22.06%, respectively. Conclusion: An anterior-only approach is recommended for cases with localized lesions and smaller angular deformities. For patients with multisegmental lesions and larger angular deformities, a posterior-only or anterior–posterior combined approach is advised, with a preference for the posterior-only approach.

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“…Currently, some researchers have begun to employ this technique in treating spinal infectious diseases such as epidural abscess, 15 purulent spondylitis, 16 and spinal tuberculosis. 17 Anti-tuberculosis drug chemotherapy remains the primary treatment method for thoracolumbar tuberculosis, often yielding positive results. The minimally invasive treatment methods for thoracolumbar tuberculosis mainly include CT-guided percutaneous catheter drainage, foraminal endoscopic lesion removal, percutaneous screw internal fixation technology, and channel-assisted small incision surgery.…”

Section: Summary Of Evidencementioning

confidence: 99%

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis Focus Removal versus Posterior Pedicle Lesion Removal, Bone Grafting, and Internal Fixation Combined with Drug Chemotherapy for Thoracolumbar Tuberculosis

Abudurexiti,

Haibier,

Yusufu

et al. 2024

IDR

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This study aims to investigate the clinical efficacy of endoscopic spinal tuberculosis focus removal, posterior pedicle lesion removal, bone grafting, and internal fixation combined with drug chemotherapy in treating thoracolumbar tuberculosis. It also seeks to summarize strategies for preventing complications and provide a reference for clinical treatment. Methods: We retrospectively analyzed 105 patients with spinal tuberculosis treated in our hospital from January 2018 to December 2022. Patients were divided into two groups: Group A (n=38), who underwent endoscopic spinal tuberculosis focus removal, and Group B (n=67), who underwent posterior pedicle lesion removal, bone grafting, and internal fixation. All patients received preoperative quadruple anti-tuberculosis drug chemotherapy (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol) for 2-4 weeks. We recorded and compared parameters such as operation time, intraoperative blood loss, postoperative drainage, recovery time, hospital stay, blood transfusion, and complications. We also compared pre-and postoperative lumbar VAS, ODI, erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, and Cobb angle to evaluate kyphotic deformity and correction. Results: Preoperative data including age, sex, body mass index, segment involvement, past medical history, smoking history, preoperative erythrocyte sedimentation rate, C-reactive protein, Procalcitonin, D-Dimer, Neutrophil to Lymphocyte ratio, hemoglobin, total protein, lumbar VAS score, lumbar ODI score, and spinal Cobb's angle showed no significant difference between the groups (P>0.05). Main postoperative indicators revealed that Group A had significantly lower lumbar VAS scores, higher hemoglobin and total protein levels, and a lower recurrence rate than Group B at the last follow-up (P<0.05). Secondary postoperative indicators showed that Group A required significantly less blood transfusion, had shorter operative time, less intraoperative blood loss, shorter postoperative hospitalization time, and lower Cobb Angle than Group B (P<0.05). Conclusion: Endoscopic spinal tuberculosis focus removal can achieve comparable safety to posterior pedicle lesion removal, bone grafting, and internal fixation, with shorter operation time, less intraoperative bleeding, lower postoperative recurrence rate, and less postoperative drainage. This method can effectively improve blood sedimentation, lumbar function, restore Cobb angle, and reduce pain, making it worthy of promotion and application.

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A prospective study comparing three different all-posterior surgical techniques in the management of thoracolumbar spinal tuberculosis

Cited by 8 publications

References 19 publications

Active tuberculosis of spine: Current updates

Active tuberculosis of spine: Current updates

Clinical efficacy of different surgical approaches in the treatment of thoracolumbar tuberculosis: a multicenter retrospective case–control study with a minimum 10-year follow-up

Retrospective Analysis of the Efficacy and Safety of Endoscopic Spinal Tuberculosis Focus Removal versus Posterior Pedicle Lesion Removal, Bone Grafting, and Internal Fixation Combined with Drug Chemotherapy for Thoracolumbar Tuberculosis

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