Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis

Sudprasert, Weera; Choovongkomol, Kongtush; Piyapromdee, Urawit; Leownorasate, Manoon

doi:10.4184/asj.2016.10.3.543

Cited by 7 publications

(5 citation statements)

References 26 publications

(51 reference statements)

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“…Among the laboratory investigations, elevated ESR and CRP levels were recommended over leukocytosis, which has proven to be less useful. 20,21 While Tan et al 22 reported that ESR was a predictive factor for neurological deficits, ESR was not a predictive factor for neurological deficits in our study. Instead, our findings were consistent with those reported by Sudprasert et al, 21,23 who observed elevated CRP levels in patients with spinal TB with neurological deficits and used an earlier decline in the CRP level postoperatively to determine neurological recovery.…”

Section: Discussioncontrasting

confidence: 70%

“…20,21 While Tan et al 22 reported that ESR was a predictive factor for neurological deficits, ESR was not a predictive factor for neurological deficits in our study. Instead, our findings were consistent with those reported by Sudprasert et al, 21,23 who observed elevated CRP levels in patients with spinal TB with neurological deficits and used an earlier decline in the CRP level postoperatively to determine neurological recovery. Similar to that study, a high CRP level (>20 mg/L) was the only laboratory indicator of neurological deficits in the univariate analysis in our study.…”

Section: Discussioncontrasting

confidence: 70%

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Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis

et al. 2023

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Background: Thoracic spinal tuberculosis (TB) causes destruction of the spine and compression of the adjacent spinal cord. This study aimed to identify the risk factors for neurological deterioration in patients with thoracic spinal TB to guide decision-making regarding immediate surgery before the onset of weakness.Methods: Demographic, clinical, laboratory, and radiologic (x-ray and magnetic resonance imaging) data of 115 patients with active thoracic spinal TB were retrospectively analyzed. Patients with neurological status categorized as Frankel grades A, B, or C (n = 71) were classified as the neurological deficit group, while those with neurological status categorized as Frankel grades D and E (n = 44) constituted the control group. Univariate and multivariate logistic regression analyses were used to predict the risk factors for neurological deficits.Results: The mean patient age was 57.2 years. The most common lesion location was the distal thoracic region (T9-L1; 62.6%). Paradiscal involvement was the most common form of involvement (73%). In the univariate analysis, the significant risk factors associated with neurological worsening were overweight (body mass index [BMI] >25), C-reactive protein level > 20 mg/L, panvertebral involvement, loss of cerebrospinal fluid posterior to the cord, cord signal changes, and canal compromise. The multivariate analysis revealed that only BMI >25 (adjusted OR = 16.18; 95% CI 1.60-163.64; P = 0.018), cord signal changes (adjusted OR = 7.42; 95% CI 1.85-29.74; P = 0.005), and canal encroachment >50% ( adjusted OR = 51.86; 95% CI 5.53-486.24; P = 0.001) were independent risk factors for predicting the risk of neurological deficits.Conclusions: Overweight (BMI >25), cord signal changes, and canal compromise >50% significantly predicted neurological deficits in patients with thoracic spinal TB. Prompt spinal surgery should be considered before progressive worsening of the neurological condition in patients with all of these risk factors.Clinical Relevance: Predictive factors for neurological deficits in thoracic spinal TB were determined. Overweight, cord signal changes, and canal compromise >50% showed predictive value. These factors can help identify patients who require early surgical intervention.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussioncontrasting

confidence: 70%

Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis

et al. 2023

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“…This finding can be explained by the mobility of the lumbosacral segment without the anterior column support and inadequate sacral fixation, usually inserting S1 pedicle screws only. In these cases, an interbody fusion may be added to support the anterior spinal column for spinal tuberculosis involving the lumbosacral segment [21,22] or extended sacral fixation such as S2AI screw [23] may be performed to prevent progressive kyphotic deformity. This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

et al. 2019

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Study DesignRetrospective cohort.PurposeTo evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments.Overview of LiteratureThe standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach.MethodsThe medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients.ResultsThe patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference.ConclusionsExtended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.

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“…In addition, the spinal nerve root or compressed dural sac can be secondarily restored by increasing the disc height. Although these procedures have satisfactory clinical outcomes, peri- and postoperative complications remain challenging problems [ 5 8 9 10 ].…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Posterior Cage Migration after Lumbar Interbody Fusion Surgery

et al. 2018

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Study DesignA retrospective clinical case series.PurposeTo determine the strength of association between cage retropulsion and its related factors.Overview of LiteratureLumbar interbody fusion with cage can obtain a firm union and can restore the disc height with normal sagittal and coronal alignment. Although lumbar interbody fusion procedures have satisfactory clinical outcomes, peri- and postoperative complications regarding the cage remain challenging.MethodsFrom January 2006 to June 2016, 1,047 patients with lumbar degenerative disc disease who underwent posterior lumbar interbody fusion or transforaminal interbody fusion at Gyeongsang National University Hospital were enrolled. Medical records and pre- and postoperative radiographs were reviewed to identify significant cage retropulsion-related factors. The associations between cage retropulsion with various risk factors were evaluated by calculating odds ratios (ORs) and 95% confidence intervals (CIs) using multiple logistic regression analysis.ResultsOf 1,229 disc levels, 16 cases (1.3%, 10 men and 6 women) had cage retropulsion. Univariate analysis revealed no significant differences between the cage retropulsion group and the no cage retropulsion group with regard to demographic data such as age, sex, weight, height, body mass index (BMI), smoking habits, presence of osteoporosis, and duration of follow-up. Multivariate analysis revealed that low BMI (OR, 0.875; 95% CI, 0.771–0.994; p=0.040), presence of screw loosening (OR, 27.400; 95% CI, 7.818–96.033; p<0.001), and pear-shaped disc (OR, 9.158; 95% CI, 2.455–34.160; p=0.001) were significantly associated with cage retropulsion.ConclusionsThis study demonstrated that low BMI, loosening of posterior instrumentation, and pear-shaped disc were associated with cage retropulsion after lumbar interbody fusion. Therefore, when performing lumbar interbody fusion with a cage, surgeons should have skillful surgical techniques for firm fixation to prevent cage retropulsion, particularly in non-obese patients.

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Impact on Neurological Recovery of Transforaminal Debridement and Interbody Fusion versus Transpedicular Decompression in Combination with Pedicle Screw Instrumentation for Treating Thoracic and Lumbar Spinal Tuberculosis

Cited by 7 publications

References 26 publications

Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis

Factors Affecting Neurological Deficits in Thoracic Tuberculous Spondylodiscitis

Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

Risk Factors for Posterior Cage Migration after Lumbar Interbody Fusion Surgery

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