An Operation for Pott's Disease of the Spine

Hibbs, Russell A.

doi:10.1001/jama.1912.04270080115010

Cited by 30 publications

(10 citation statements)

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“…Posterior spinal fusion had been advocated and used extensively by Albee [34] and Hibbs [35] in the management of spinal TB. Furthermore, in 1946, Alexander performed a lateral decompression with preservation of the spinal stability by avoiding the laminae and posterior intervertebral joints [33].…”

Section: Managementmentioning

confidence: 99%

Spinal Tuberculosis: Diagnosis and Management

et al. 2012

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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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Section: Managementmentioning

confidence: 99%

Spinal Tuberculosis: Diagnosis and Management

et al. 2012

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“…Posterior spinal fusion with bone grafting alone was introduced in 1911 by Hibbs and Albee [2,3]. It was however, demonstrated independently by McKee and Seddon [4,5] around 1937 that posterior bone grafting alone had either no palpable benefit and was even harmful in the presence of active tuberculosis.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the study was to assess the functional and radiological outcomes of isolated posterior instrumented fusion in skeletally mature adults having tuberculous spondylitis with active disease that was associated with paraplegia of early onset in many patients. We suggest that posterior instrumented fusion alone is sufficient in adults with tuberculous spondylitis due to the following reasons: (1) effective chemotherapy is available at present to sterilize the vertebral body lesions without the need for aggressive anterior debridement or fusion, (2) complications peculiar to anterior approaches to the dorsolumbar spine can be avoided, (3) posterior instrumentation serves to minimize the progress of kyphosis, while the anterior vertebral body lesion is healing, (4) para-spinal abscess, if present can be drained through the posterior approach itself, and (5) since the lesion heals with anterior inter-body bony fusion, there is no need for posterior bone grafting also.…”

Section: Introductionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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“…Albee [1] and Hibbs [10] independently reported fusion for spinal stabilization in the early 1900s. Since then, surgeons have come to rely on achieving solid fusion.…”

Section: Discussionmentioning

confidence: 99%

CT-based classification of long spinal allograft fusion

et al. 2007

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Anterior column reconstruction of the thoracolumbar spine by structural allograft has an increased potential for biological fusion when compared to synthetic reconstructive options. Estimation of cortical union and trabecular in-growth is, however, traditionally based on plain radiography, a technique lacking in sensitivity. A new assessment method of bony union using high-speed spiral CT imaging is proposed which reflects the gradually increasing biological stability of the construct. Grade I (complete fusion) implies cortical union of the allograft and central trabecular continuity. Grade II (partial fusion) implies cortical union of the structural allograft with partial trabecular incorporation. Grade III (unipolar pseudarthrosis) denotes superior or inferior cortical non-union of the central allograft with partial trabecular discontinuity centrally and Grade IV (bipolar pseudarthrosis) suggests both superior and inferior cortical non-union with a complete lack of central trabecular continuity. Twenty-five patients underwent anterior spinal reconstruction for a single level burst fracture between T4 and L5. At a minimum of two years follow up the subjects underwent high-speed spiral CT scanning through the reconstructed region of the thoracolumbar spine. The classification showed satisfactory interobserver (kappa score = 0.91) and intraobserver (kappa score = 0.95) reliability. The use of high-speed CT imaging in the assessment of structural allograft union may allow a more accurate assessment of union. The classification system presented allows a reproducible categorization of allograft incorporation with implications for treatment.

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An Operation for Pott's Disease of the Spine

Abstract: The treatment of Pott's disease, or humpback, by immobilization of the diseased joints has long been the accepted method and is accomplished by various mechan-Flg. 1.-Spinous processes pni-tlally fractured and used for bl'ldg-Ing the gap between the vcrtcln'tc.

Cited by 30 publications

References 0 publications

Spinal Tuberculosis: Diagnosis and Management

Spinal Tuberculosis: Diagnosis and Management

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

CT-based classification of long spinal allograft fusion

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