One-stage Surgical Management for Multilevel Tuberculous Spondylitis of the Upper Thoracic Region by Anterior Decompression, Strut Autografting, Posterior Instrumentation, and Fusion

Zhang, Hongqi; Guo, Chaofeng; Xungang, Xiao; Wen-rong, Long; Deng, Zhihong; Chen, Jing

doi:10.1097/01.bsd.0000211281.68400.1b

Cited by 63 publications

(56 citation statements)

References 8 publications

(6 reference statements)

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“…Some scholars have expressed concern that lesions confined to the vertebral body could spread to the lamina of the vertebra and spinous process to result in infectious meningitis. However, standard antituberculosis chemotherapy can prevent recurrence and metastasis of tuberculosis [4,18,19], while the current relevant literature and our study show that such complications are rare [19,20]. Compared with patients treated with anterior approach, patients treated with posterior approach are more conducive to drainage of residual lesions postoperatively in the supine position because of gravity.…”

Section: Discussionmentioning

confidence: 63%

“…Patients with upper thoracic spinal tuberculosis often suffer from severe spinal cord damage and kyphotic deformity requiring surgical treatment. Anterior debridement and bone grafting and either anterior or posterior internal fixation have been performed by many researchers as an effective treatment for thoracic spinal tuberculosis [2][3][4][5]. However, this procedure may carry a risk of cardiopulmonary complications and prolong recovery time.…”

Section: Introductionmentioning

confidence: 99%

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One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

et al. 2012

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Purpose To investigate the clinical efficacy and feasibility of one-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterioronly approach. Methods Fourteen patients (eight males, six females) with upper thoracic tuberculosis whose lesions were confined to two adjacent segments were admitted to our hospital. Their ages ranged from 23 to 72 years (average, 50 years). The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. ASIA classification showed that preoperatively, one patient was grade A, two patients were grade B, eight patients were grade C, and three patients were grade D. All patients were treated with one-stage surgical treatment by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach. Patients were evaluated preoperatively and postoperatively by measurement of thoracic kyphotic angles using Cobb angle evaluation, determination of erythrocyte sedimentation rate (ESR), evaluation of ASIA impairment scale, and radiological examination. Results Operation time ranged from 70 to 135 min, (average, 110 min). Intraoperative blood loss ranged from 200 to 950 mL (average, 450 mL). All patients were followed up for 22 to 48 months postoperatively (average, 31.5 months). No sinus tract formation, cerebrospinal meningitis, or recurrence of tuberculosis occurred. All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 12°-26°postoperatively, and at final follow-up were 13°-28°. The ESR recovered to normal within 6 months postoperatively in all patients. Bone fusion was achieved within 3-8 months (average, 5.5 months). Conclusions One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

et al. 2012

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“…Thus, anterior debridement combined with posterior fusion and fixation was developed [3,10,12,13,[25][26][27], which enables immediate and sufficient stabilization after kyphosis correction. Table 4 summarizes published reports focused on treatment of active spinal tuberculosis with kyphosis of more than 30°.…”

Section: Discussionmentioning

confidence: 99%

Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity

Wang

et al. 2011

International Orthopaedics (SICOT)

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“…When necessary, the combined anterior and posterior approaches have been reported to be superior in lumbar and multilevel thoracic disease. 42,43 Brucellosis is an important endemic infection commonly seen in Mediterranean countries. Spinal involvement may simulate tuberculosis but often involves the lumbar spine.…”

Section: Non-pyogenic Infectionmentioning

confidence: 99%

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

Moritani

Kim²,

Capizzano³

et al. 2014

BJR

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The incidence of spinal infections has increased in the past two decades, owing to the increasing number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use. Conventional MRI is the gold standard for diagnostic imaging; however, there are still a significant number of misdiagnosed cases. Diffusion-weighted imaging (DWI) with a b-value of 1000 and apparent diffusion coefficient (ADC) maps provide early and accurate detection of abscess and pus collection. Pyogenic infections are classified into four types of extension based on MRI and DWI findings: (1) epidural/paraspinal abscess with spondylodiscitis, (2) epidural/ paraspinal abscess with facet joint infection, (3) epidural/paraspinal abscess without concomitant spondylodiscitis or facet joint infection and (4) intradural abscess (subdural abscess, purulent meningitis and spinal cord abscess). DWI easily detects abscesses and demonstrates the extension, multiplicity and remote disseminated infection. DWI is often a key image in the differential diagnosis. Important differential diagnoses include epidural, subdural or subarachnoid haemorrhage, cerebrospinal fluid leak, disc herniation, synovial cyst, granulation tissue, intra-or extradural tumour and post-surgical fluid collections. DWI and the ADC values are affected by susceptibility artefacts, incomplete fat suppression and volume-averaging artefacts. Recognition of artefacts is essential when interpreting DWI of spinal and paraspinal infections. DWI is not only useful for the diagnosis but also for the treatment planning of pyogenic and nonpyogenic spinal infections.Spinal and paraspinal infections include vertebral osteomyelitis, spondylodiscitis, infectious facet arthropathy, epidural infections, meningitis, myelitis and infections of paraspinal soft tissue and musculature. Evidence of spinal infections has been discovered in the remains of prehistoric humans from 7000 BC. 1 The incidence has increased in the past two decades, owing to the rising number of elderly patients, immunocompromised conditions, spinal surgery and instrumentation, vascular access and intravenous drug use.1-4 Despite advances in medical knowledge, imaging modalities and surgical interventions, the diagnosis of this entity is still challenging since the clinical features can be subtle and misleading. MRI including post-contrast studies is the gold standard for diagnostic imaging. However, although MRI has relatively high diagnostic sensitivity, specificity and accuracy, there are still a significant number of challenging cases. In such cases, diagnostic delays and suboptimal management can result in irreversible paralysis, critical sepsis and even death.Diffusion-weighted imaging (DWI) has proven to be a useful tool for the diagnosis of a variety of intracranial infections especially in the detection of brain abscesses and pus collections, which encompass subdural and epidural empyema, purulent meningitis and ventriculitis. [5][6][7][8] Therefore, DWI ...

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One-stage Surgical Management for Multilevel Tuberculous Spondylitis of the Upper Thoracic Region by Anterior Decompression, Strut Autografting, Posterior Instrumentation, and Fusion

Abstract: Single-stage anterior debridement, strut autografting, posterior instrumentation, and fusion proved safe and effective for MTSUTR, which can achieve goals of complete spinal cord decompression and good deformity correction.

Cited by 63 publications

References 8 publications

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity

Pyogenic and non-pyogenic spinal infections: emphasis on diffusion-weighted imaging for the detection of abscesses and pus collections

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