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Archives of Orthopaedic and Trauma Surgery

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01-12-2012 | Orthopaedic Surgery

Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

Authors: Hong Qi Zhang, Jin Song Li, Shu Shan Zhao, Yu Xiong Shao, Shao Hua Liu, Qi Gao, Min Zhong Lin, Jin Yang Liu, Jian Huang Wu, Jing Chen

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 12/2012

Abstract

Purpose

To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly.

Materials and methods

This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B.

Results

All patients were followed up for an average of 35.1 ± 5.8 months (range 26–45 months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups.

Conclusion

Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.

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Garcia-Rodriguez JF, Alvarez-Diaz H, Lorenzo-Garcia MV, Marino-Callejo A, Fernandez-Rial A, Sesma-Sanchez P (2011) Extrapulmonary tuberculosis: epidemiology and risk factors. Enferm Infecc Microbiol Clin 29(7):502–509PubMedCrossRef

Peto HM, Pratt RH, Harrington TA, LoBue PA, Armstrong LR (2009) Epidemiology of extrapulmonary tuberculosis in the United States, 1993–2006. Clin Infect Dis 49(9):1350–1357PubMedCrossRef

Sandher DS, Al-Jibury M, Paton RW, Ormerod LP (2007) Bone and joint tuberculosis: cases in Blackburn between 1988 and 2005. J Bone Joint Surg Br 89(10):1379–1381PubMedCrossRef

Wells WA, Konduri N, Chen C, Lee D, Ignatius HR, Gardiner E, Schwalbe NR (2010) Tuberculosis regimen change in high-burden countries. Int J Tuberc Lung Dis 14(12):1538–1547PubMed

Zevallos M, Justman JE (2003) Tuberculosis in the elderly. Clin Geriatr Med 19(1):121–138PubMedCrossRef

Moon MS (1997) Tuberculosis of the spine controversies and a new challenge. Spine 22(15):1791–1797PubMedCrossRef

Al-Sebai MW, Al-Khawashki H, Al-Arabi K, Khan F (2001) Operative treatment of progressive deformity in spinal tuberculosis. Int Orthop 25(5):322–325PubMedCrossRef

Ha R, Sf E (1960) Anterior spine fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment in the first 100 cases. J Bone Joint Surg Am 42:295–310

Hirakawa A, Miyamoto K, Masuda T, Fukuta S, Hosoe H, Iinuma N, Iwai C, Nishimoto H, Shimizu K (2010) Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. J Spinal Disord Tech 23(2):133–138PubMedCrossRef

10.

Zhang HQ, Lin MZ, Shen KY, Ge L, Li JS, Tang MX, Wu JH, Liu JY (2012) Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg 132(6):751–757PubMedCrossRef

11.

Zhang HQ, Wang YX, Guo CF, Zhao D, Deng A, Wu JH, Liu JY (2011) One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Childs Nerv Syst 27(5):735–742PubMedCrossRef

12.

Gong K, Wang Z, Luo Z (2011) Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. Arch Orthop Trauma Surg 131(2):217–223PubMedCrossRef

13.

Currie S, Galea-Soler S, Barron D, Chandramohan M, Groves C (2011) MRI characteristics of tuberculous spondylitis. Clin Radiol 66(8):778–787PubMedCrossRef

14.

Lu M (2010) Imaging diagnosis of spinal intramedullary tuberculoma: case reports and literature review. J Spinal Cord Med 33(2):159–162PubMed

15.

Jain AK, Dhammi IK (2007) Tuberculosis of the spine: a review. Clin Orthop Relat Res 460:39–49PubMedCrossRef

16.

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K (1995) Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine 20(12):1410–1418PubMed

17.

Bailey HL, Gabriel M, Hodgson AR, Shin JS (1972) Tuberculosis of the spine in children. Operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 54(8):1633–1657PubMed

18.

Molinari RW, Bridwell KH, Klepps SJ, Baldus C (1999) Minimum 5-year follow-up of anterior column structural allografts in the thoracic and lumbar spine. Spine 24(10):967–972PubMedCrossRef

19.

Mohan Sahoo M, Kumar Mahapatra S, Chandra Sethi G, Kumar Dash S (2012) Posterior only approach surgery for fixation and decompression of thoraco-lumbar spinal tuberculosis: a retrospective study. J Spinal Disord Tech Jul 30 [Epub ahead of print]

20.

Zhang H, Sheng B, Tang M et al (2012) One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach. Eur Spine J [Epub ahead of print]

21.

Friedlaender GE (1987) Bone grafts. The basic science rationale for clinical applications. J Bone Joint Surg Am 69(5):786–790PubMed

22.

Govender S, Kumar KP (2003) Cortical allografts in spinal tuberculosis. Int Orthop 27(4):244–248PubMedCrossRef

23.

Govender S, Parbhoo AH (1999) Support of the anterior column with allografts in tuberculosis of the spine. J Bone Joint Surg Br 81(1):106–109PubMedCrossRef

24.

Govender S (2002) The outcome of allografts and anterior instrumentation in spinal tuberculosis. Clin Orthop Relat Res 398:60–66PubMedCrossRef

25.

Robertson PA, Wray AC (2001) Natural history of posterior iliac crest bone graft donation for spinal surgery: a prospective analysis of morbidity. Spine 26(13):1473–1476PubMedCrossRef

26.

Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913PubMedCrossRef

27.

Younger EM, Chapman MW (1989) Morbidity at bone graft donor sites. J Orthop Trauma 3(3):192–195PubMedCrossRef

28.

Ozdemir HM, Us AK, Ogun T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine 28(5):474–479PubMed

Title: Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches
Authors: Hong Qi Zhang
Jin Song Li
Shu Shan Zhao
Yu Xiong Shao
Shao Hua Liu
Qi Gao
Min Zhong Lin
Jin Yang Liu
Jian Huang Wu
Jing Chen
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 12/2012
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-012-1618-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

Abstract

Purpose

Materials and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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