Surgical Treatment of Lumbar Tuberculous Spondylodiscitis by Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Instrumentation

Zaveri, Gautam; Mehta, Satyen

doi:10.1097/bsd.0b013e31818859d0

Cited by 68 publications

(49 citation statements)

References 22 publications

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“…Lumbo-sacral tuberculosis surgery is performed with the aim of debriding the focus of infection as completely as possible, restoring nerve function and reconstructing spinal stability. For lumbo-sacral tuberculosis, especially L4-L5 and L5-S1 tuberculosis, posterior debridement and bone-graft fusion is usually adopted by researchers for fear of impairing the presacral nerve and great vessels [13,14]. Zaveri and Mehta [14] treated 15 cases of lumbar and lumbo-sacral tuberculosis (four L5-S1) with transforaminal lumbar interbody fusion and pedicle screw fixation.…”

Section: Discussionmentioning

confidence: 99%

Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

2011

International Orthopaedics (SICOT)

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Purpose Both the antero-posterior and anterior approaches have been used for treating L5-S1 vertebral tuberculosis. However, no studies have compared the efficacy of the two methods in treating the disease. Methods The antero-posterior (AP group, 14 cases) and anterior (A group, 13 cases) approaches were performed on L5-S1 vertebral tuberculosis cases who were followed up for average of 25 months. Clinical and radiographic data were obtained from and compared between groups. Results Average operative time, blood loss and pre-operative, post-operative and last follow-up of lumbo-sacral angles for groups AP and A were 497 min vs 190 min, 980 ml vs 410 ml, 22.3°vs 20.6°, 29.8°vs 25.7°and 28.3°vs 23.6°, respectively. Averaged visual analogue scale (VAS) scores in groups AP and A, respectively, were 6.5 vs 6.0 points before surgery and 3.0 vs 2.8 points after surgery. Mean ODI scores were 60.2 vs 63.0 points before and 30.0 vs 28.5 points after the operation for groups AP and A, respectively. Six cases in the AP group and five in the A group who exhibited neurological symptoms recovered to American Spinal Injury Association (ASIA) grade E. The average hospitalisations of groups AP and A lasted for 21 and 15 days, respectively. Bony fusion was achieved in both groups, with an average fusion time of five and four months, respectively. Conclusions Both the antero-posterior and anterior approaches can effectively heal L5-S1 vertebral tuberculosis, but the average surgical time, blood loss and hospital stay following the anterior approach are prominently less than those following the antero-posterior approach.

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Section: Discussionmentioning

confidence: 99%

Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

2011

International Orthopaedics (SICOT)

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“…It is also obvious that the failure of conservative measures, compression of neural elements, mechanical derangement (instability, malalignment, severe bone destruction), and intractable pain demands surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment and correction of instability [7,8,18]. However, surgeons still discuss staging, surgical access, and usage of instrumentation or cages [3,14,15,20]. Furthermore, minimally invasive and endoscopic surgeries are being promoted [9,11].…”

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confidence: 99%

Failure modes in conservative and surgical management of infectious spondylodiscitis

et al. 2012

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Purpose and methods We reviewed the management, failure modes, and outcomes of 196 patients treated for infectious spondylodiscitis between January 1, 2000 and December 31, 2010, at the Spinal Unit, Aarhus University Hospital, Aarhus, Denmark. Patients with infectious spondylodiscitis at the site of previous spinal instrumentation, spinal metastases, and tuberculous and fungal spondylodiscitis were excluded. Results Mean age at the time of treatment was 59 (range 1-89) years. The most frequently isolated microorganism was Staphylococcus aureus. The lumbosacral spine was affected in 64 % of patients and the thoracic in 21 %. In 24 % of patients, there were neurologic compromise, four had the cauda equina syndrome and ten patients were paraplegic. Ninety-one patients were managed conservatively. Treatment failed in 12 cases, 7 patients required re-admission, 3 in-hospital deaths occurred, and 5 patients died during follow-up. Posterior debridement with pedicle screw instrumentation was performed in 75, without instrumentation in 19 cases. Seven patients underwent anterior debridement alone, and in 16 cases, anterior debridement was combined with pedicle screw instrumentation, one of which was a two-stage procedure. Re-operation took place in 12 patients during the same hospitalization and in a further 12 during follow-up. Two in-hospital deaths occurred, and five patients died during follow-up. Patients were followed for 1 year after treatment. Eight (9 %) patients treated conservatively had a mild degree of back pain, and one (1 %) patient presented with mild muscular weakness. Among surgically treated patients, 12 (10 %) had only mild neurological impairment, one foot drop, one cauda equine dysfunction, but 4 were paraplegic. Twenty-seven (23 %) complained of varying degrees of back pain. Conclusions Conservative measures are safe and effective for carefully selected patients without spondylodiscitic complications. Failure of conservative therapy requires surgery that can guarantee thorough debridement, decompression, restoration of spinal alignment, and correction of instability. Surgeons should master various techniques to achieve adequate debridement, and pedicle screw instrumentation may safely be used if needed.

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“…Most of the reported case series preferred anterior approach [8,11,20] or combined approach executed either as one-or two-staged procedure [8,10,13,21,22]. Posterior approach addressing both column pathology has been widely accepted in tumor surgery [23,24], yet there are few reports on posterior approach for vertebral osteomyelitis with majority of reported cases dealing with lumbar spine pathology [25][26][27][28][29]. Reconstruction of anterior column was performed mostly using iliac crest bone graft [27][28][29] or even employing transdiscal osteotomy with vertebral shortening [25].…”

Section: Discussionmentioning

confidence: 99%

“…Posterior approach addressing both column pathology has been widely accepted in tumor surgery [23,24], yet there are few reports on posterior approach for vertebral osteomyelitis with majority of reported cases dealing with lumbar spine pathology [25][26][27][28][29]. Reconstruction of anterior column was performed mostly using iliac crest bone graft [27][28][29] or even employing transdiscal osteotomy with vertebral shortening [25]. Present case series, on the other hand, report on posterior approach for one or multilevel thoracic and lumbar pyogenic osteomyelitis utilizing cages for anterior column reconstruction.…”

Section: Discussionmentioning

confidence: 99%

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

et al. 2012

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Purpose Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction. Methods Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8-56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (KirkaldyWillis criteria). Results Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1-4) days in ICU and were able to walk unaided 1.6 (1-2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1-18) degrees, with loss of correction of 4 (0-19) degrees at final follow-up. Conclusions Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine.It proved to be less invasive resulting in faster postoperative recovery.

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Surgical Treatment of Lumbar Tuberculous Spondylodiscitis by Transforaminal Lumbar Interbody Fusion (TLIF) and Posterior Instrumentation

Abstract: Transforaminal lumbar interbody fusion with pedicle screw fixation is a simple, safe, and effective procedure for treatment of selected patients suffering from lumbar and lumbosacral tuberculosis.

Cited by 68 publications

References 22 publications

Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis

Failure modes in conservative and surgical management of infectious spondylodiscitis

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

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