Costotransversectomy in thoracic spinal tuberculosis

Abstract

Background: The escalating global pandemic of tuberculosis infections results in 8 million new cases diagnosed each year. The thoracic and thoracolumbar spine is the most prevalent area involved in musculoskeletal tuberculosis. Deformity with associated neurological compromise, requiring extended in-patient treatment and rehabilitation, is common.Multidrug-resistant tuberculosis is prevalent and tissue samples are needed to obtain bacterial culture and sensitivity. Decompression of the spinal canal, directly or indirectly, should accelerate neurological recovery. Methods:A retrospective study was performed at Tygerberg Hospital to evaluate the efficacy of costotransversectomy in spinal thoracic tuberculosis with regard to neurological recovery and deformity. Neurological status was compared at 6 months post-operatively with the pre-surgical status. The end deformity was compared with Rajasakeran's equation.Results: Thirty patients met the inclusion criteria, with an average age of 37 years. Fifteen patients were HIV positive, and ten of them on highly active antiretroviral therapy (HAART). The average CD4 count was 235.The mean neurological status of the group was classified as Frankel C, but this improved to Frankel D at 6 months post-surgery. Initial sagittal deformity was 18.7°, which increased to 26° one year post-operatively. This was not significantly different from the 25.6° kyphosis predicted by the Rajasekaran formula. A 67% positive culture yield for TB was obtained which compared favourably to percutaneous transpedicular needle biopsies performed at the same institute which had a yield of 56%. Conclusions:Costotransversectomy is a simple procedure resulting in indirect decompression of the spinal cord, improving the microbiological diagnosis of spinal tuberculosis, and possibly leading to earlier neurological recovery, without the risk of creating further instability and greater deformity.

Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report

“…A study by Botha et al showed costotransversectomy approach resulted in indirect decompression and is statistically significant in improving neurological deficit ( p = 0.01) six months after surgery. However, initial sagittal deformity was 18.7° and increased to 26° one year post-operatively [ 12 ].…”

“…In addition, the posterior approach also provides lower morbidity and complication rates, and provides better kyphosis correction than the anterior approach [ 10 ].Posterior instrumentation is reported for speedy recovery and lower rate of deformity progression [ 11 ]. In occasions where the anterior and lateral column can be accessed safely, posterior and posterolateral approach is recommended for thoracic and lumbar spine surgery through transpedicular, transfacetal, costotranversectomy, or extrapleural approaches [ [12] , [13] , [14] ]. Here we present a spinal tuberculosis paraplegia treated with posterior approach through costotransversectomy.…”

Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report

“…A study by Botha et al showed costotransversectomy approach resulted in indirect decompression and is statistically significant in improving neurological deficit ( p = 0.01) six months after surgery. However, initial sagittal deformity was 18.7° and increased to 26° one year post-operatively [ 12 ].…”

“…In addition, the posterior approach also provides lower morbidity and complication rates, and provides better kyphosis correction than the anterior approach [ 10 ].Posterior instrumentation is reported for speedy recovery and lower rate of deformity progression [ 11 ]. In occasions where the anterior and lateral column can be accessed safely, posterior and posterolateral approach is recommended for thoracic and lumbar spine surgery through transpedicular, transfacetal, costotranversectomy, or extrapleural approaches [ [12] , [13] , [14] ]. Here we present a spinal tuberculosis paraplegia treated with posterior approach through costotransversectomy.…”

Spinal Tuberculosis: Current Concepts

“…98,99 They can be transpedicular, transfacetal, costotranversectomy, or extrapleural approaches. 100,101 Though transpedicular and transfacetal approaches can be used with ease in lumbar spine, reconstruction could be a challenge in thoracic spine without performing costotranversectomy. This approach is an extrapleural approach that allows decompression of spinal cord under direct vision and also allows placement of structural support anteriorly.…”

Active tuberculosis of spine: Current updates

“…Several posterior and posterolateral approaches to the thoracic and lumbar spine have been identified, allowing for safe access to the anterior and lateral columns [64 , 70 , 71] . They may be extrapleural, transpedicular, transfacetal, or include a costotransversectomy [72 , 73] .

Fig.

…”

Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report

“…A study by Botha et al showed costotransversectomy approach resulted in indirect decompression and is statistically significant in improving neurological deficit ( p = 0.01) six months after surgery. However, initial sagittal deformity was 18.7° and increased to 26° one year post-operatively [ 12 ].…”

“…In addition, the posterior approach also provides lower morbidity and complication rates, and provides better kyphosis correction than the anterior approach [ 10 ].Posterior instrumentation is reported for speedy recovery and lower rate of deformity progression [ 11 ]. In occasions where the anterior and lateral column can be accessed safely, posterior and posterolateral approach is recommended for thoracic and lumbar spine surgery through transpedicular, transfacetal, costotranversectomy, or extrapleural approaches [ [12] , [13] , [14] ]. Here we present a spinal tuberculosis paraplegia treated with posterior approach through costotransversectomy.…”

Spinal Tuberculosis: Current Concepts

“…98,99 They can be transpedicular, transfacetal, costotranversectomy, or extrapleural approaches. 100,101 Though transpedicular and transfacetal approaches can be used with ease in lumbar spine, reconstruction could be a challenge in thoracic spine without performing costotranversectomy. This approach is an extrapleural approach that allows decompression of spinal cord under direct vision and also allows placement of structural support anteriorly.…”

Active tuberculosis of spine: Current updates

“…Several posterior and posterolateral approaches to the thoracic and lumbar spine have been identified, allowing for safe access to the anterior and lateral columns [64 , 70 , 71] . They may be extrapleural, transpedicular, transfacetal, or include a costotransversectomy [72 , 73] .

Fig.

…”

Anterior and posterior fusion via a posterior and costotransversectomy approach for thoracic spinal tuberculosis: A case report

“…A study by Botha et al showed costotransversectomy approach resulted in indirect decompression and is statistically significant in improving neurological deficit ( p = 0.01) six months after surgery. However, initial sagittal deformity was 18.7° and increased to 26° one year post-operatively [ 12 ].…”

“…In addition, the posterior approach also provides lower morbidity and complication rates, and provides better kyphosis correction than the anterior approach [ 10 ].Posterior instrumentation is reported for speedy recovery and lower rate of deformity progression [ 11 ]. In occasions where the anterior and lateral column can be accessed safely, posterior and posterolateral approach is recommended for thoracic and lumbar spine surgery through transpedicular, transfacetal, costotranversectomy, or extrapleural approaches [ [12] , [13] , [14] ]. Here we present a spinal tuberculosis paraplegia treated with posterior approach through costotransversectomy.…”

Spinal Tuberculosis: Current Concepts

“…98,99 They can be transpedicular, transfacetal, costotranversectomy, or extrapleural approaches. 100,101 Though transpedicular and transfacetal approaches can be used with ease in lumbar spine, reconstruction could be a challenge in thoracic spine without performing costotranversectomy. This approach is an extrapleural approach that allows decompression of spinal cord under direct vision and also allows placement of structural support anteriorly.…”

Active tuberculosis of spine: Current updates

“…Several posterior and posterolateral approaches to the thoracic and lumbar spine have been identified, allowing for safe access to the anterior and lateral columns [64 , 70 , 71] . They may be extrapleural, transpedicular, transfacetal, or include a costotransversectomy [72 , 73] .

Fig.

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