Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine

Abstract

We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status. The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8 degrees. Loss of correction was maximal in the lumbosacral spine at 13.7 degrees. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%. We conclude that adjuvant posterior stabilisation allows early mobilisation and rehabilitation. Graft-related problems were fewer and the progression and maintenance of correction of the kyphosis were better than with anterior surgery alone. There is no additional risk relating to the use of an implant either posteriorly or anteriorly even when large quantities of pus are present.

Titanium cages in the surgical treatment of severe vertebral osteomyelitis

“…Expandable cages have the advantage of a primary stable anchorage and avoidance of the donor site morbidity that occurs with structural autologous bone graft harvesting. Both the present study and studies by other authors have demonstrated that the use of metallic implants in an infected area of the spine does not lead to persistence or recurrence of the infection [4,8,19,21]. In addition to stabilisation of the spine, the good perfusion of the vertebral bodies and adequate soft tissue coverage of the anterior thoracolumbar spine (including immunologically active structures such as the peritoneum) are regarded as the main factors contributing to the success of this technique [4,12].…”

“…However, an increasing number of studies advocate a combination of posterior stabilisation and anterior debridement and interbody fusion. The advantages of this technique are better correction of the kyphotic deformity and its maintenance, and earlier patient mobilisation [1,5,7,8,11,14,15,19].…”

“…Sundararaj et al [19] reported on 16 patients with tuberculosis of the spine who were surgically treated with anterior debridement and fusion using a titanium mesh cage and posterior stabilisation. The infection was eradicated in all cases.…”

“…The reported techniques of surgical treatment range from anterior debridement and interbody fusion [13], debridement and internal fixation from the posterior approach [17] to combined single-stage or twostage posterior instrumentation with anterior debridement and bone grafting [1,5,7,8,11,14,15,19]. Anterior instrumentation or the use of cages has been anecdotally reported, but there is a critical discussion concerning the role of spinal implants in the presence of infection [4,8,19,21].…”

The anterior stand-alone approach (ASAA) during the acute phase of spondylodiscitis: results in 40 consecutively treated patients

“…Metal implants were considered to hinder healing of the infections with increased rates of septic loosening [15,16]. Indeed, extensive clinical and surgical studies uphold the choice of synthetic material implantation during the acute infective phase of vertebral osteomyelitis [13].…”