Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine

Laheri, Vinod; Badhe, Nitin P.; Dewnany, G.

doi:10.1038/sj.sc.3101185

Cited by 75 publications

(61 citation statements)

References 21 publications

(8 reference statements)

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“…The decompression was adequate as indicated by the neurological recovery in most of the cases in accordance with available literature showing neurological recovery varying from 82 to 95% recovery of ambulatory status [17,18]. Adequate debridement and decompression also makes room for healthy cancellous bone apposition resulting in high fusion rates [19,20]. We did not include patients with multilevel disease or those with severe kyphosis.…”

Section: Discussionmentioning

confidence: 66%

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Kapoor

Agrawal

et al. 2012

International Orthopaedics (SICOT)

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Purpose Video-assisted thoracoscopic surgery (VATS) has become an alternative tool for a variety of spinal conditions as this approach minimises much morbidity related to conventional thoracotomy. The purpose of this study was to determine the efficacy of VATS and its long-term results in patients with dorsal spinal tuberculosis. Materials and methods This retrospective long-term follow-up study of VATS-assisted surgical treatment of dorsal spine tuberculosis included 30 patients with a mean age of 33.5 years (range 15-60). Patients with dorsal spine tuberculosis who were suitable surgical candidates for VATS underwent a three-portal thoracoscopy for decompression with/without fusion of the spine along with routine chemotherapy for tuberculosis (TB). Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of hospital stay, neurological recovery, and progression of deformity. Patients were observed for a minimum of five years. Results The mean duration of surgery was 158.8 min (range 90-220 min) with mean blood loss of 296.7 ml (range 200-450 ml). Complications were seen in ten patients. The mean follow-up was 80 months (range 60-90 months) with neurological improvement and return of ambulatory power in all patients at final follow-up. There was an average increase in kyphus angle by 7.5°at final follow-up and 95% of patients achieved an excellent or good subjective outcome. Conclusion VATS-assisted surgical decompression can be a safe and effective technique for anterior debridement and fusion in tuberculosis of the dorsal spine to achieve neurological recovery with reduced morbidity, blood loss, and hospital stay compared to thoracotomy.

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Section: Discussionmentioning

confidence: 66%

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Kapoor

Agrawal

et al. 2012

International Orthopaedics (SICOT)

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“…It is clear that posterior instrumentation is more effective in kyphosis correction and prevention of late-term progression especially in kyphosis with two or more levels of involvement or in moderate or severe kyphosis [12,15,17,26,29]. In a study, Wen-Jer et al [31] has obtained 56% kyphosis correction with two-stage anterior-posterior surgery and reported 3°of correction loss during the follow-up period.…”

Section: Discussionmentioning

confidence: 99%

“…Klockner et al [16] suggested that posterior instrumentation should be combined with anterior debridement and fusion in deformities affecting many levels and/or in excessive kyphotic deformities. Laheri et al [17] achieved 62.5% correction performing costotransversectomy and decompression, anterior interbody fusion and posterior instrumentation at the same stage in patients with kyphosis due to tuberculosis with dorsolumbar involvement and reported an average of 3.2°correction loss in kyphosis angle following 5.8 years of follow-up period.…”

Section: Discussionmentioning

confidence: 99%

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

et al. 2010

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We retrospectively studied the cases with tuberculous spondylitis of thoracolumbar region with two or more levels of involvement that underwent posterior instrumentation and fusion and anterior fusion with titanium mesh following anterior decompression using simultaneous successive posterior-anterior-posterior surgery. Among all patients with tuberculous spondylitis accompanied by medium or severe kyphosis, 20 patients who underwent simultaneous successive decompression, fusion and instrumentation with posterior-anterior-posterior surgery between 1999 and 2004 were included in the study. Patients were evaluated for fusion formation and neurological and functional status. Kyphosis angles were measured at early and long-term follow-up. Antituberculosis chemotherapy was initiated in all patients and continued for 9 months; initially as quadruple therapy for 3 months, and then as triple therapy. Average follow-up period was 52.7 months (range 37-94). Solid fusion was achieved in all patients. All patients returned to their previous occupation; 75% (15 subjects) with mild pain or no pain and 15% (3 subjects) with major limitations. There were 11 patients with neurological deficit, 9 of these achieved complete neurological recoveries. Regarding kyphosis angle, an average 35.1°correction (84.8%) was obtained in postoperative period (p \ 0.001) and there was no significant correction loss during the follow-up period (p \ 0.05). There were no grafts or instrumentation-related stabilization problems. In subjects with tuberculous spondylitis with involvements at two or more levels accompanied by medium and severe kyphosis, decompression, fusion and instrumentation by simultaneous successive posterior-anterior-posterior surgery is an effective and safe management method for effective kyphosis correction with high fusion rates.

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“…Following the advent of modern spinal instrumentation systems, several authors have reported combined anterior and posterior fusion either as a single-stage or as a twostage procedure following the initial description of the procedure by Yau et al [12][13][14][15][16][17][18][19][20][21][22][23] in 1974. Earlier apprehensions regarding the use of metal implants in the presence of active tubercular infection were overcome following the realization that tubercle bacilli had slow rates of division, lower bacillary counts than pyogenic infections, and do not produce adhesion molecule and bio-film [24,25].…”

Section: Discussionmentioning

confidence: 99%

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Kumar¹,

Joseph²,

Manur³

2012

Eur Spine J

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Purpose The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoracolumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation. Methods The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years. Results The mean kyphotic angle improved from 32.4°p re-operatively to 7.2°in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5°at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages. Conclusion Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.

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Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine

Cited by 75 publications

References 21 publications

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

Thoracoscopic decompression in Pott’s spine and its long-term follow-up

The results of simultaneous posterior–anterior–posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

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