The outcome of posterior instrumented fusion in spinal tuberculosis
Keywords:
posterior decompression, posterior stabilization, spinal tuberculosisAbstract
Introduction:
Spinal tuberculosis can cause serious morbidity and deformity. Treatment ranging from antituberculosis drugs to surgical, and the combination thereof. In the present study, authors have shown the results of posterior decompression and posterior stabilization (PDPS) only. The purpose of this retrospective study is to evaluate the clinical and radiologic outcomes of spinal tuberculosis treated with PDPS only.
Methods:
This retrospective study reviewed twenty two patients with thoracic, thoracolumbar and lumbar tuberculosis who were treated with PDPS only. There were seven males and fifteen females with a mean age of 39.3+15.4 years. The mean follow-up period was 22.6+13.4 months and the minimum duration of follow up was 12 months. Clinical outcomes (Visual Analog Scale/VAS, Short Form 36/SF-36, Os-westry Disability Index/ODI, Frankel) and radiologic results were analyzed.
Results:
The infection was resolved in all patients with no recurrence and we found no complication, intra-operative or post-operative. Mean VAS score decreased from 8.9 to 1.3 and mean ODI score also decreased from 78.9 to 10.7. The patients’s physical and mental health outcomes were improved using SF-36 survey instrument. There were significant neurologic improvement at the final follow-up based on Frankel classification. The mean kyphotic angle preoperatively was 22.6±15.7 degree which corrected to a mean of 14.9±8.0 degree with mean loss of correction of 2.8 degree at the final follow up. Fourteen (63.6%) cases achieved bony fusion.
Conclusion:
PDPS only is a safe and effective procedure for treating spinal tuberculosis, with good improve-ment in clinical and radiologic outcomes.
Downloads
References
Saptawati L, Mardiastuti, Karuniawati A, Rumende CM. Evaluasi metode fastpla-quetbtm untuk mendeteksi mycobacterium tuberculosis pada sputum di beberapa unit pelayanan kesehatan di Jakarta- Indonesia. Jurnal Tuberkulosis Indonesia. 2012:8:1-6
Global tuberculosis report 2017. Geneva: World Health Organization; 2017. Licence: AC BY-NCSA 3.0 IGO
Gupta A, Jain Prateek, Thakur Ravikant, Sharma Shashikant. Posterior only debride-ment and instrumentation in thoracolumbar spinal tuberculosis. International Journal of Orthopaedics Sciences 2017;3(2):38-42
Liu Z et al. One stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. The Scientific World Journal.2014. Article ID 137106, 6 pages. http://dx.doi.org/10.1155/2014/137106.Acce ssed November 12, 2017.
Kumar M, Joseph B, Manur R. Isolated post-erior instrumentation for selected cases of thoracolumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting. European Spine Journal. 2013:22:624-632
D’Souza AR, Mohapatra B, Bansal ML, Das K Role of posterior stabilization and trans-pedicular decompression in the treatment of thoracic and thoracolumbar TB. Clin Spine Surg. 2017;00:000-000.
Singh S, Dawar H, Das K, Mohapatra B, Pra-sad S. Functional and radiological outcomes of anterior decompression and posterior sta-bilization via posterior transpedicular ap-proach in thoracic and thoracolumbar Pott’s disease: A Retrospective Study. Asian Spine J 2017;11(4):618-626.
Li W, Liu J, Gong L, Zhou Y, Duan D. Post-erior intervertebral space debridement, annu-lar bone grafting and instrumentation for treatment of lumbosacral tuberculosis. BMC Surg. 2017;17:124.
Gupta A, Jain P, Thakur R, Sharma S. Post-erior only debridement and instrumentation in thoracolumbar spinal tuberculosis. Interna-tional Journal of Orthopaedics Sciences 2017;3(2):38-42
Lee J. S, Moon K.P, Kim S.J, Suh K.T. Post-erior lumbar interbody fusion and posterior instrumentation in the surgical management of lumbar tuberculous spondylitis J Bone Joint Surg [Br] 2007;89-B:210-14.
Dai Y, Li Y, Wang B, Lv G. Anterior versus posterior surgery for mono-segmental thorac-ic spinal tuberculosis: selection of the optim-al approach and comparison of outcomes. Int J Clin Exp Med 2017;10(7):10463-10471.
Jain A, Jain R.K, Kiyawat V. Evaluation of Outcome of Transpedicular Decompression and Instrumented Fusion in Thoracic and Thoracolumbar Tuberculosis. Asian Spine J 2017;11(1):31-36
Zhou L. et al, A comparative study of three approaches for the treatment of lumbosacral tuberculosis. Acta Orthop. Belg.2017:83: 330 339
Sahoo M. Et al, Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis. A Re trospective Study. J Spinal Disord Tech 2012;25:E217–E223
