Outcome Of Minimal Invasive Surgery Approach For Spine Infection: A Systematic Review
DOI:
https://doi.org/10.31282/joti.v7n3.135Keywords:
spondylitis tuberculosis, infection, approach, minimal invasive surgeryAbstract
Introduction: Minimally invasive surgery (MIS) has gained popularity as an alternative to conventional surgery, with potential benefits including reduced blood loss, faster recovery, and shorter hospital stays. However, evidence regarding its use in tuberculous spondylitis remains limited. This systematic review evaluated the outcomes of MIS for spinal tuberculosis.
Methods: PubMed, EMBASE, and the Cochrane Library were searched for studies evaluating MIS for tuberculous spondylitis published up to June 7, 2019. Study selection was performed independently according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. No restrictions were applied regarding patient demographics, MIS technique, or publication status. Data extracted included surgical approach, functional and radiological outcomes, intraoperative outcomes, length of hospital stay, follow-up duration, and complications.
Results: Of 81 articles identified, 10 studies involving 431 patients met the eligibility criteria. More than 110 patients underwent conventional open surgery, while more than 321 underwent MIS. MIS techniques included posterior pedicle screw fixation, plate fixation, lateral nail-bar fixation, and bilateral pedicle screw fixation, with C-arm or X-ray fluoroscopy used for intraoperative visualization. Follow-up ranged from 1 to 40 months. Overall, MIS was associated with satisfactory functional outcomes and few reported complications.
Conclusions: MIS appears to provide satisfactory outcomes with a low complication rate in patients with tuberculous spondylitis. However, the available evidence is limited, and further long-term, well-designed comparative studies are needed to establish its safety and effectiveness.
Downloads
References
1. Jiang, J. et al. Effect of computer navigation-assisted minimally invasive direct lateral interbody fusion in the treatment of patients with lumbar tuberculosis. 1–7 (2016).
2. Guo, S. et al. Percutaneous Pedicle Screw Fixation Alone Versus Debridement and Fusion Surgery for the Treatment of Early Spinal Tuberculosis: A Retrospective Cohort Study. Medical Science Monitor 25, 1549–1557 (2019).
3. C., S., M., G. & H.-J., A. Surgical treatment of spondylodiscitis. Surgical Infections (2003).
4. Wang, Q. et al. A novel indication for a method in the treatment of lumbar tuberculosis through minimally invasive extreme lateral interbody fusion (XLIF) in combination with percutaneous pedicle screws fixation in an elderly patient: A case report. Medicine (United States) (2016) doi:10.1097/MD.0000000000005303.
5. Guo, S. et al. Percutaneous Pedicle Screw Fixation Alone Versus Debridement and Fusion Surgery for the Treatment of Early Spinal Tuberculosis: A Retrospective Cohort Study. Medical Science Monitor 25, 1549–1557 (2019).
6. Xu, Z., Wang, X. & Liu, Z. One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up. J Orthop Surg Res 15, 473 (2020).
7. Yang, H. et al. Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients. Journal of Clinical Neuroscience (2016) doi:10.1016/j.jocn.2015.11.036.
8. Wang, Q. Y. et al. One-stage extreme lateral interbody fusion and percutaneous pedicle screw fixation in lumbar spine tuberculosis. Journal of Musculoskeletal Neuronal Interactions (2017).
9. Zou, M.-X., Wang, X.-B., Li, J., Lv, G.-H. & Deng, Y.-W. Spinal tuberculosis of the lumbar spine after percutaneous vertebral augmentation (vertebroplasty or kyphoplasty). The Spine Journal 15, e1–e6 (2015).
10. Yin, X. H. et al. Treatment of pediatric spinal tuberculosis abscess with percutaneous drainage and low-dose local antituberculous therapy: a preliminary report. Child’s Nervous System 31, 1149–1155 (2015).
11. Yang, H. et al. Minimally invasive surgery through the interlaminar approach in the treatment of spinal tuberculosis: A retrospective study of 31 patients. Journal of Clinical Neuroscience 32, 9–13 (2016).
12. Lai, Z., Shi, S., Fei, J., Han, G. & Hu, S. A comparative study to evaluate the feasibility of preoperative percutaneous catheter drainage for the treatment of lumbar spinal tuberculosis with psoas abscess. J Orthop Surg Res 13, 290 (2018).
13. Li, T., Ma, Z., Zhang, Y., Xu, H. & Lei, W. Therapeutic effect of minimally invasive catheter drainage and local chemotherapy for the lumbosacral tuberculosis without neural symptoms. Medicine 98, e15941 (2019).
14. Kandwal, P., Garg, B., Upendra, B. N., Chowdhury, B. & Jayaswal, A. Outcome of minimally invasive surgery in the management of tuberculous spondylitis. Indian J Orthop 46, 159–164 (2012).
15. Yin, X. H. et al. Treatment of pediatric spinal tuberculosis abscess with percutaneous drainage and low-dose local antituberculous therapy: a preliminary report. Child’s Nervous System 31, 1149–1155 (2015).
16. Xiong, W. et al. Minimally invasive far lateral debridement combined with posterior instrumentation for thoracic and lumbar tuberculosis without severe kyphosis. J Orthop Surg Res 15, 221 (2020).
17. Viezens, L. et al. Spontaneous Pyogenic Spondylodiscitis in the Thoracic or Lumbar Spine: A Retrospective Cohort Study Comparing the Safety and Efficacy of Minimally Invasive and Open Surgery Over a Nine-Year Period. World Neurosurgery (2017) doi:10.1016/j.wneu.2017.02.129.
18. Gan, F. et al. Minimally invasive direct lateral interbody fusion in the treatment of the thoracic and lumbar spinal tuberculosisMini-DLIF for the thoracic and lumbar spinal tuberculosis. BMC Musculoskeletal Disorders (2018) doi:10.1186/s12891-018-2187-3.
19. Yang, H. et al. Management of spine tuberculosis with chemotherapy and percutaneous pedicle screws in adjacent vertebrae: A retrospective study of 34 cases. Spine (2016) doi:10.1097/BRS.0000000000001858.
