Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine

Hassan, Khaled; Elmorshidy, Essam

doi:10.1007/s00586-016-4451-2

Cited by 72 publications

(55 citation statements)

References 29 publications

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“…It allows direct access to the pathology, adequate debridement, adequate decompression, and the ability to place a large graft. But it is more challenging in patients with lumbarsacral spinal infections due to the complicated regional anatomy, and may increase the risk of surgery-related morbidity [17]. Also, anterior instrumentation at L4-L5 and L5-S1 is potentially dangerous and insubstantial [18].…”

Section: Discussionmentioning

confidence: 99%

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis

Abulizi

Muheremu

et al. 2017

BMC Surg

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BackgroundSpinal brucellosis is a less commonly reported infectious spinal pathology. There are few reports regarding the surgical treatment of spinal brucellosis in existing literature. This retrospective study was conducted to determine the effectiveness of single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral spinal brucellosis.MethodsFrom February 2012 to April 2015, 32 consecutive patients (19 males and 13 females, mean age 53.7 ± 8.7) with lumbosacral brucellosis treated by transforaminal decompression, debridement, interbody fusion, and posterior instrumentation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Surgical outcomes were evaluated based on visual analogue scale (VAS), Oswestry Disability Index (ODI) and Japanese Orthopaedic Association (JOA) scale. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria.ResultsThe mean follow-up period was 24.9 ± 8.2 months. Back pain and radiating leg pain was relieved significantly in all patients after operation. No implant failures were observed in any patients. Wound infection was observed in two patients and sinus formation was observed in one patient. Solid bony fusion was achieved in 30 patients and the fusion rate was 93.8%. The levels of ESR and CRP were returned to normal by the end of three months’ follow-up. VAS and ODI scores were significantly improved (P < 0.05). According to JOA score, surgical improvement was excellent in 22 cases (68.8%), good in 9 cases (28.1%), moderate in 1 case (3.1%) at the last follow-up.ConclusionsSingle-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation is an effective and safe approach for lumbosacral brucellosis.

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Section: Discussionmentioning

confidence: 99%

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis

Abulizi

Muheremu

et al. 2017

BMC Surg

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“…19 We retrospectively analysed the data of 43 patients who underwent single-stage posterior debridement with bone graft fusion and internal fixation and found that single posterior surgery had a shorter surgical duration and lower intraoperative bleeding volume than single anterior surgery (P < 0.05); these data are in line with a report by Zhou et al 20 We believe that this finding may be related to the greater experience in performing pedicle screw implantation and short-segment fixation of posterior pedicle screws in patients with a lower rate of loss of the kyphosis correction angle by posterior than anterior surgery (P < 0.05), which is consistent with previous reports. 21,22 In this retrospective analysis, the anterior surgical approach for thoracic TB allowed us to directly reach and thoroughly remove the lesion, enabled bone grafting and internal fixation within a larger field of vision, and achieved the goal of reconstructing the mechanical structure of the spine. Anterior surgery is more anatomically complex than posterior surgery, and several important vessels, nerves, and organs are present in front of the spine.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal tuberculosis

Liu

Luo²,

Wang

et al. 2020

J Int Med Res

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Objective: The type of surgical treatment that should be adopted for thoracic tuberculosis (TB) remains controversial. This study was performed to compare the clinical efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal TB. Methods: Seventy-eight patients with thoracic TB undergoing surgical treatment were divided into two groups on the basis of the surgical methods employed: Group A (single anterior debridement þ bone graft fusion and internal fixation) and Group B (single posterior debridement þ bone graft fusion and internal fixation). Results of clinical and imaging examinations were analysed and compared between the two groups. Results: The surgical duration and mean hospital stay were significantly longer and the perioperative bleeding volume was significantly higher in Group A than B. At the last follow-up, changes in the American Spinal Injury Association grade showed no obvious differences between the two groups. Before and after the surgery and at the last follow-up, no significant differences were detected in the Cobb angle change or correction rate between the two groups. Conclusion: Surgery via the single anterior and single posterior approaches achieved good clinical efficacy in the treatment of thoracic spinal TB.

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“…Dai et al [6] performed X-ray measurements of the anterior, middle, and posterior heights of thoracic and lumbar vertebrae in 124 normal subjects to calculate normal reference values for Chinese patients in clinical studies. However, the magnification differences between X-ray measurements and in vivo values will lead to errors in measurement results.…”

Section: Discussionmentioning

confidence: 99%

Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae

Zhang

et al. 2016

Med Sci Monit

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BackgroundThe key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical anterolateral fixation through digital measurement of computed tomography (CT) data to identify relevant anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults.Material/MethodsWe performed digital measurement of anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Abbreviations: Left height of vertebral body, LHV; Right height of vertebral body, RHV; Anterior height of vertebral body, AHV; Middle height of vertebral body, MHV; Posterior height of vertebral body, PHV; Superior sagittal diameter of vertebral body, SSDV; Superior transverse diameter of vertebral body, STDV; inferior sagittal diameter of vertebral body, ISDV; Inferior transverse diameter of vertebral body, ITDV; (1) Left (right) height of vertebral body, [L(R)HV]; Anterior (middle, posterior) height of vertebral body [A(M,P)HV]; Superior (inferior) sagittal diameter of vertebral body, [S(I)SDV]; Superior (inferior) transverse diameter of vertebral body, [S(I)TDV].ResultsThe transverse diameters of vertebral bodies were always larger than the sagittal diameter for 3~4 mm. The distance between 2 vertebrae (interval of 1 vertebra) range were (52–56) mm for T4–T7 and (44–48) mm for T8–T12, and the surgeons could collate these data to choose a suitable stick length.ConclusionsBone graft should prune into laterigrade cuboid, it can recover A-P and bilateral physiological functions load, and the height of the vertebral body increased from T4 to T12.

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Anterior versus posterior approach in surgical treatment of tuberculous spondylodiscitis of thoracic and lumbar spine

Cited by 72 publications

References 29 publications

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis

Single-stage transforaminal decompression, debridement, interbody fusion, and posterior instrumentation for lumbosacral brucellosis

Efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal tuberculosis

Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae

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