Comparison of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic spinal tuberculosis in adults

Liang

et al. 2022

Preprint

Background: With the widespread use of the posterior surgery, more and more surgeons chose posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and posterior surgical approaches and presented our views.Methods: This study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information.Results: Patients in the anterior group and the posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P>0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P<0.05).Conclusions: Both anterior and posterior approaches are feasible for thoracic and lumbar tuberculosis. However, the anterior approach has greater advantages in kyphotic correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.

Section: Discussionsupporting

confidence: 92%

Comparison of Anterior or Posterior Approach in Surgical Treatment of Thoracic and Lumbar Tuberculosis: a Retrospective Case-control Study

Liang

et al. 2022

Preprint

BMC Musculoskelet Disord

“…The intervention method of the MIS method is percutaneous while the open surgery including anterior radical debridement with graft fusion or posterior debridement with fusion and fixation with huge invasiveness and more blood loss [22,52].…”

Section: The Differences Between Our Mis Methods Andmentioning

confidence: 99%

Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis — a long-term retrospective study of 106 cases

Zhang

Hao

Wang

et al. 2020

Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.

“…Standard systemic anti‐TB chemotherapy remains the basic strategy throughout the entire treatment period 18 , 19 . In our study, normative anti‐TB treatments were carried out on all patients for 2 weeks preoperatively and for 12–18 months postoperatively.…”

Section: Discussionmentioning

confidence: 99%

Medium‐Term Follow‐Up Outcomes of One‐Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

Zhang

Wang

et al. 2021

Orthopaedic Surgery

Self Cite

Objective: To evaluate the medium-term outcomes of one-stage posterior lumbosacral or lumbopelvic fixation treatment of lumbosacral junction tuberculosis in adults.Methods: This retrospective study enrolled a total of 38 adult patients (24 males and 14 females) with an average age of 48.0 AE 13.0 years (range, 25-75 years) during the period from February 2008 to July 2015. All patients were treated by one-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. After pedicle screw or iliac screw fixation, a hemi-laminectomy or laminectomy was performed on the severely damaged side of the lesion segment. Intervertebral bone grafting and intertransverse bone grafting were performed after clearing the focus of tuberculosis. All cases were followed up for at least 5 years. Intraoperative blood loss, operative time, erythrocyte sedimentation rate (ESR), pain intensity was assessed by visual analog scale (VAS) score; neurological function was assessed by Japanese Orthopaedic Association (JOA) score; quality of life was assessed by Oswestry Disability Index (ODI); functional outcome, lumbosacral angle, and fusion time were gathered and analyzed. All data expressed as mean AE standard deviation.Results: During the 66.2 AE 4.4 months (range, 60-78 months) follow-up, all patients achieved clinical cure without severe complications. The intraoperative blood loss was 726.3 AE 151.9 mL (range, 400-1100 mL) and the operative time was 137.6 AE 22.5 min (range, 110-200 min). The ESR decreased to normal levels within (11.8 AE 2.6 mm/h) 3 months postoperatively. The VAS score significantly decreased from 6.8 AE 1.1 preoperatively to 0.8 AE 0.7 at the final follow-up (P < 0.01). The mean JOA improved from preoperative 18.5 AE 2.9 to 26.9 AE 1.1 at the last visit (P < 0.01). The mean ODI was 44.3 AE 6.7 and significantly decreased to 9.3 AE 1.9 at the final observation (P < 0.01). Patient-reported outcomes as measured by Kirkaldy-Willis criteria were excellent in 21 cases, good in 16 cases, and fair in one case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7 AE 1.8 to the postoperative values of 26.4 AE 1.4 (P < 0.01), with an angle loss of 1.2 AE 0.7 at the last follow-up. Bone fusion occurred on average 12.8 AE 1.9 months (range, 9-15 months) after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow-up. Conclusion:One-stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is an effective and highly safe procedure to treat lumbosacral junction tuberculosis in adults.