The Role of Anterior Spinal Instrumentation and Allograft Fibula for the Treatment of Pott Disease

Özdemir, Hacı Mustafa; Us, Ali Kemal; Öğün, Tunç Cevat

doi:10.1097/01.brs.0000048666.17934.17

Cited by 70 publications

(45 citation statements)

References 25 publications

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“…The retroperitoneal approach requires careful protection of the ureter, lumbosacral plexus, and sympathetic chain [34]. Similar series have reported on major vascular injuries [35], deep venous thrombosis [11,36], pneumothorax, haemothorax, atelectasis and pneumonia [11,36,37], urinary tract infections [11], secondary non-specific infection [36][37][38] occasionally necessitating re-debridement and implant removal [35], hardware failure or breakage [12,38], and death due to pulmonary insufficiency [11,38].…”

Section: Discussionmentioning

confidence: 97%

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

El-Sharkawi

Said

2011

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to present our experience in treating dorso-lumbar tuberculosis by one-stage posterior circumferential fusion and to compare this group with a historical group treated by anterior debridement followed by postero-lateral fusion and stabilization. Methods Between 2003 and 2008, 32 patients with active spinal tuberculosis were treated by one-stage posterior circumferential fusion and prospectively followed for a minimum of two years. Pain severity was measured using Visual Analogue Scale (VAS). Neurological assessment was done using the Frankel scale. The operative data, clinical, radiological, and functional outcomes were also compared to a similar group of 25 patients treated with anterior debridement and fusion, followed 10-14 days later by posterior stabilization and postero-lateral fusion. Results The mean operative time and duration of hospital stay were significantly longer in the two-stage group. The mean estimated blood loss was also larger, though insignificantly, in the two-stage group. The incidence of complications was significantly lower in the one-stage group. At final follow-up, all 34 patients with pre-operative neurological deficits showed at least one Frankel grade of neurological improvement, all 57 patients showed significant improvement of their VAS back pain score, the mean kyphotic angle has significantly improved, all patients achieved solid fusion and 43 (75.4%) patients returned to their pre-disease activity level or work. Conclusion Instrumented circumferential fusion, whether in one or two stages, is an effective treatment for dorso-lumbar tuberculosis. One-stage surgery, however, is advantageous because it has lower complication rate, shorter hospital stay, less operative time and blood loss.

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Section: Discussionmentioning

confidence: 97%

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

El-Sharkawi

Said

2011

International Orthopaedics (SICOT)

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“…Anterior debridement and arthrodesis allow reaching the focal point of the disease directly, effective debridement of the focal point, rapid bony union with the grafts and prevent progressive collapse and kyphosis [12,20,21,30,32]. However, it has been reported that such successful outcomes are not observed regarding progressive collapse and kyphosis, particularly in the case of two or more levels of involvement, risks of graft insufficiency and increased kyphotic deformity [1,3,9,11,15,23,25]. Moon et al stated that interbody fusion performed with classical anterior radical surgery per se in ineffective in the correction of kyphosis.…”

Section: Discussionmentioning

confidence: 99%

“…The kyphotic correction and cord decompression achieved by radical anterior intervention as described by Hodgson and Stock may be under risk with the collapses, breaks or insufficiency problems that may result resorption in the grafts used [12,22,26,29]. The reinforcement of correction performed in kyphotic deformity with posterior or anterior instrumentation prevents the collapse or breakdown of the graft, decreases pseudoarthrosis rate, and allows early ambulation and rehabilitation [1,2,6,9,12,15,16,22,25,26,29,31,33].…”

Section: Introductionmentioning

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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“…Oga et al in 1993 demonstrated that bio-film formation and adherence of mycobacterium tuberculosis to the metallic implants is negligible making them susceptible to host defence mechanism and anti-tuberculous drugs [14]. Their findings removed the phobia of using instrumentation in active spinal tuberculosis [14,15] leading many surgeons to use instrumentation posteriorly in addition to the anterior procedure [16][17][18][19][20] or anteriorly [21][22][23][24] with good results.…”

Section: Surgery In Active Diseasementioning

confidence: 99%

Kyphotic deformity in spinal tuberculosis and its management

Rajasekaran

2012

International Orthopaedics (SICOT)

127

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Spinal tuberculosis is the most common cause of severe kyphosis in many parts of the world. Three percent of patients treated conservatively end up with a deformity greater than 60 degrees which can cause serious cosmetic, psychological, cardio-respiratory and neurological problems. Severe kyphotic deformities are usually the result of childhood spinal deformities and 'Spine at risk' radiological signs are helpful to identify children at risk of deformity. In children, a severe type of collapse, termed as 'Buckling Collapse' is also noted where the kyphosis is more than 120 degrees. Risk factors for buckling collapse include an age of less than seven years at the time of infection, thoracolumbar involvement, loss of more than two vertebral bodies and the presence of radiographic 'Spine-at-risk' signs. In correction of established deformity, posterior only surgery with a variety of osteotomies is now preferred. In patients with deformity of more than 90 degrees, an opening-closing wedge osteotomy must be done to prevent neurological deficit.

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The Role of Anterior Spinal Instrumentation and Allograft Fibula for the Treatment of Pott Disease

Abstract: The use of anterior spinal stabilization accompanied with a structural allograft fibula is effective after proper radical débridement for interbody fusion, deformity correction, and maintenance in cases of multisegment-involved Pott disease.

Cited by 70 publications

References 25 publications

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

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

Kyphotic deformity in spinal tuberculosis and its management

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