The role of debridement and reconstruction of sagittal balance in tuberculous spondylitis

Abstract

Background:An accepted comprehensive clinical approach to the deformed spine with tuberculous infection is still lacking. We aimed to determine the usage of a staged algorithm in the treatment of kyphotic spine with tuberculous infection and to present the clinical results of the patients treated with the help of this protocol.Materials and Methods:54 patients (28 females, 26 males) with a mean age of 39.2 (22-76) years. Preoperative, early postoperative, and followup clinical and radiologic results were evaluated retrospectively. The patients were classified into Kaplan A (kyphotic deformity <30°), Kaplan B (kyphotic deformity 30°-60°) and Kaplan C (kyphotic deformity >60°). They were operated by posterior instrument with anterior debridment (Kaplan A), debridment with anterior bone grafting (Kaplan B) and anterior column resection and bone grafting in Kaplan C.Results:Tuberculous involvement were seen at more than one level in 40 patients and paraspinal abscess were detected in 31. Preoperative focal kyphotic deformity was reconstructed with an average of 19 (9-38) degrees. Twenty-six patients had neurologic compromise with different severities and 12 of them improved after the surgical intervention. Improvement in work ability and pain status was detected in 52% and 61% of the patients, respectively. Wound complications responding to medical care were detected in nine patients. Initial kyphotic deformity was found as an important parameter in selecting the surgical procedure.Conclusion:Regarding resected amount of infected osseous material, as planned preoperatively, have resulted with better concordance between anterior and posterior column heights and better sagittal alignment. We could correct kyphosis and improve sagittal balance with staged algorithm as used by us.

Determinants of Neurological Outcome in Surgically Treated Patients of Pott's Spine

“…Radiological outcome (both X-ray and MRI) also showed a significant reduction from more severe to less severe grades and a significant increase in Cobb's Angle. Similar to results of present study, some other workers 7,8,12,13 , who surgically intervened for correction of kyphosis also showed a significant increase in Cobb's angle. In present study, at final evaluation (i.e.…”

“…This high proportion of females could be associated with low socio-economic class, poor nutritional status and unhygienic living conditions of women who primarily were housewives and hence were more vulnerable to tuberculosis. Similar to present study, Akinyoola et al (2007) 10 and Gokce et al (2012) 7 in their studies also found spinal tuberculosis to be more common in females (51.02% and 51.85% respectively) as compared to males (48.97% and 48.14% respectively). A sizeable proportion of patients in present study (46.7%) had onset of disease for >3 months, thus showing a general lack of awareness regarding signs and symptoms of disease which are responsible for late reporting and deterioration to more severe grades of disease.…”

Correlation between Degree of Gibbus Angulation, Neurological Deficits, and Pain in Spondylitis Tuberculosis Patients

“…Gibbus angulation were classified into: 1) severe, >60°; 2) moderate, 30-60°; and 3) mild, <30°. 7 The gibbus was measured with cobb angle (the angle was made by drawing a line through the superior surface of the first normal vertebrae cephalad at upper-end plate to the lesion and a line through the inferior surface of the first normal caudal, lower end plate, to the lesion). Perpendiculars were drawn from these line and cobb angle was measured at their section ( Fig.).…”

Surgical treatment of thoracolumbar tuberculosis

“…5 Subsequently it has been shown that anterior instrumentation also is very safe so far as the problem of persistent infection relating to the usage of foreign body is concerned. 5,6,7 Potential advantages of spinal instrumentation are correction of deformity, increased rate of fusion, especially multilevel spinal fusion, early mobilization, wider resection of unhealthy bone without fear of instability and addressing the problem of instability when present. The treatment objective in tuberculosis of the spine is to avoid the sequelae of neural complications and achieve the healed status with a near-normal spine.…”