Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults

St, Wang; Hl, Ma; Chen, Lin; Ph, Chou; Liu, CL; Wk, Yu; Mc, Chang

doi:10.1302/0301-620x.98b6.36472

Cited by 23 publications

(26 citation statements)

References 22 publications

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“…Since the combined anterior and posterior approach overcomes the limitations of poor stability and correction associated with the single anterior approach, it has been used widely. However, the combined approach is associated with excessive intraoperative bleeding, prolonged operation time, increased length of hospital stage, and a relatively high risk of complications [6, 7, 20, 21]. Wang et al [20] evaluated 28 patients with thoracolumbar TB who underwent surgery using the combined anterior and posterior approach.…”

Section: Discussionmentioning

confidence: 99%

“…However, the anterior approach does not provide adequate leverage for the correction of kyphosis; moreover, fixation performed through the anterior approach necessitates the ligation of the segmental arteries owing to the risk of massive bleeding [4, 5]. The combined use of anterior and posterior approach in a single-stage surgery serves to overcome the limitations of the anterior-only approach and has been widely adopted with good results [6, 7]. It should be noted that the use of a combined anterior and posterior approach increases the operation time, and is associated with greater trauma and higher risk of complications, not conducive to early rehabilitation of patients [3].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis

Zhou¹,

Li²,

Li³

et al. 2018

BMC Surg

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BackgroundTo compare the clinical efficacy of single posterior debridement, bone grafting and instrumentation with that of single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal tuberculosis (TB).MethodsWe performed a retrospective analysis of 64 adult patients with thoracic and thoracolumbar spinal TB who underwent surgery between January 2011 and December 2014. Of the 64 patients, 34 patients were treated using a single posterior-only approach (posterior debridement, bone grafting and instrumentation; Group A). Thirty patients were treated with a combined anterior and posterior approach (single-stage anterior debridement, bone grafting and posterior instrumentation; Group B). Clinical manifestations, laboratory and imaging results were subjected to statistical analysis.ResultsThe mean (±standard deviation) duration of follow-up was 16.8 ± 1.4 months (range, 10–34). Bony fusion was achieved in all the bone grafts with no loosening or breakage of internal fixation. In both of the groups, the visual analog scale (VAS) pain score, ESR and CRP at 6 weeks after operation and at the most recent follow-up were significantly lower than the preoperative level (p < 0.05). The operation time, intraoperative blood loss and length of hospital stay in group A were significantly less than those in group B (P < 0.05). As of most recent follow-up, no significant between-group difference was observed with respect to the American Spinal Injury Association classification status (p > 0.05). Furthermore, no significant between-group difference was observed with respect to preoperative kyphosis angle, and postoperative angle correction and angle correction rate (P > 0.05). One patient in group A relapsed 20 months after operation, and was successfully treated with debridement using the combined anterior and posterior approach.ConclusionSingle posterior debridement, bone grafting and instrumentation for treatment of thoracic and thoracolumbar spinal TB can achieve similar curative effect as that with single-stage anterior debridement, bone grafting and posterior instrumentation, and is associated with additional advantages of shorter operation time, less bleeding and shorter length of hospital stay.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis

Zhou¹,

Li²,

Li³

et al. 2018

BMC Surg

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“…Wang et al [7] reported that STB patients who underwent only posterior instrumentation and posterolateral fusion without anterior debridement could obtain lesion healing and solid bony fusion without TB recurrence during a mean follow-up of 68.8 months. Zhang et al [8] suggested that spinal stability should be prioritized as TB lesion could not be radically eliminated at the microbiological level.…”

Section: Discussionmentioning

confidence: 99%

Comparative study of a single posterior approach and combined posterior-anterior approach for patients with lower lumbar tuberculosis

Cui¹,

Gong²,

Zhou³

et al. 2020

Preprint

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Background To compare the surgical effect of a single posterior approach with a combined posterior-anterior approach for patients with lower lumbar tuberculosis (TB). Method: 119 cases of lower lumbar TB were conducted from January 2008 to December 2016 using two procedures. Out of 119 cases, 73 patients were operated with a single posterior approach (group A), whereas, 46 patients were operated using the combined posterior-anterior approach (group B). The evaluative items were compared between two groups, including operation time, blood loss, surgical complication rate, cure rate, Visual Analog Scale (VAS) score, Japanese Orthopaedic Association (JOA) score, kyphosis Cobb’s angle, and time of abscess disappearance. Furthermore, the period between bone graft fusion and the patients’ return to regular activity were compared between the two groups to evaluate the therapeutic effects. Results No significant differences of gender, age, BMI, illness duration, and preoperative indexes of VAS, JOA, ESR, CRP, and kyphosis Cobb’s angle were found between the two groups of patients, who were followed-up for 24–60 months. Although the operation time and blood loss rate were less in group A as compared to group B, no remarkable differences in VAS, JOA, ESR, CRP and kyphosis Cobb’s angle were found. Furthermore, the rate of surgical complications, cure rate, and time of bone graft fusion did not show appreciable differences between the two groups. However, the time of abscess disappearance and time return to regular activity were less in group B as opposed to patients of group A. Conclusion Both single posterior approach and combined posterior-anterior approach are effective for the treatment of lower lumbar TB with a high cure rate and low surgical complication rate. Addtionally, single posterior approach is less traumatic than the combined posterior-anterior approach, but with a much slower lesion healing and activity recovery.

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“… 12 Studies have demonstrated that fixation or fusion from two levels above the affected segment to two levels below the lesion provide greater stability and maintain correction of the kyphotic angle, especially in patients with a relatively osteoporotic spine. 20 , 21 However, equivalent neurological recovery and patient-reported outcomes were obtained in patients undergoing either an AR or a PO procedure and therefore, more studies are required to further explore this issue and the related clinical significance.…”

Section: Discussionmentioning

confidence: 99%

Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review

Liu

Chen

Lou

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

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ObjectiveThis study aimed to conduct a systematic review of literature comparing the clinical effectiveness and safety between anterior reconstruction (AR) and posterior osteotomy (PO) in the treatment of Kümmell's disease with neurological deficits.MethodsWe systematically reviewed the literature in PubMed, EMBASE, Cochrane Database of Systematic Reviews, and the Web of Science for “spin*,” “surg*,” “Kümmell's disease,” “Kummell's disease,” “Kummell disease,” “vertebral osteonecrosis,” “vertebral pseudarthrosis,” “intravertebral vacuum cleft,” “delayed vertebral collapse,” and “compression fracture nonunion”. Quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation method.ResultsA total of 10 publications involving 268 Kümmell's disease patients with neurological deficits were included in this review, with 7 studies of low- or very low-quality. There were 37.7% and 62.3% of patients receiving AR and PO, respectively. For clinical outcomes, AR group showed no significant differences in pain, neurological dysfunction, and imaging outcome improvements compared with patients who underwent PO. However, the incidence of implant-related complications including loose screw, screw fracture, screw disconnection, and plate dislodgment, was higher in AR group compared with PO group (21.6% vs. 14.3%). As another major complication, AR group more often required a second surgery.ConclusionThis systematic review demonstrated that both AR and PO could improve pain, neurological dysfunction and imaging outcomes. However, serious comorbidities, multilevel corpectomies and/or severe osteoporosis highly required PO. Design discrepancies were found in the current studies, further higher-quality studies are warranted.Level of evidenceLevel III, therapeutic study.

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Anterior debridement may not be necessary in the treatment of tuberculous spondylitis of the thoracic and lumbar spine in adults

Cited by 23 publications

References 22 publications

Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis

Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis

Comparative study of a single posterior approach and combined posterior-anterior approach for patients with lower lumbar tuberculosis

Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review

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