Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Spine Journal
Published in: European Spine Journal 3/2013

01-03-2013 | Original Article

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Authors: Malhar N. Kumar, Bushan Joseph, Ravikiran Manur

Published in: European Spine Journal | Issue 3/2013

Login to get access

Abstract

Purpose

The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation.

Methods

The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years.

Results

The mean kyphotic angle improved from 32.4° pre-operatively to 7.2° in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5° at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages.

Conclusion

Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.
Literature
1.
Moon M-S (2006) Development in the management of tuberculosis of the spine. Curr Orthop 20:132–140CrossRef
2.
Hibbs RA (1911) An operation for Pott’s disease of the spine. J Am Med Assoc 59:433–436
3.
Albee FH (1911) Transplantation of a portion of the tibia into the spine for Pott’s disease. A preliminary report. J Am Med Assoc 57:885–886CrossRef
4.
McKee GK (1937) A comparison of the results of spinal fixation operation and non-operative treatment in Pott’s disease in adults. Br J Surg 24:456–468CrossRef
5.
Seddon HJ (1938) Pott’s paraplegia, prognosis and treatment. Br J Surg 22:769CrossRef
6.
Ito H, Asami T (1934) A new radical operation for Pott’s disease. Report of ten cases. J Bone Jt Surg 15:499
7.
Hodgson AR, Stock FE (1956) Anterior spinal fusion. A preliminary communication on radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg 44:266–275PubMedCrossRef
8.
Rajasekaran S, Soundarapandian S (1989) Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Jt Surg Am 71:1314–1323
9.
Tuli SM (2010) Tuberculosis of the skeletal system, 4th edn. Jaypee Publishers, Delhi, p 215
10.
Schofferman J, Slosar P, Reynolds J, Goldthwaite N, Koestler M (2001) A prospective randomized comparison of 270 degree fusions to 360 degree fusions (circumferential fusions). Spine 26(10):E207–E212PubMedCrossRef
11.
Kim KT, Lee SH, Lee YH, Bae SC, Suk KS (2006) Clinical outcomes of 3 fusion methods through the posterior approach in the lumbar spine. Spine 31(12):1351–1357PubMedCrossRef
12.
Yau AC, Hsu LC, O’Brien JP, Hodgson AR (1974) Tuberculous kyphosis correction with spinal osteotomy, halo pelvis distraction and anterior and posterior fusion. J Bone Jt Surg Am 56:1419–1434
13.
Moon MS (1991) Combined posterior instrumentation and anterior inter-body fusion for active tuberculosis kyphosis of the thoraco-lumbar spine. Curr Orthop 5:177CrossRef
14.
Louw JA (1990) Spinal tuberculosis with neurological deficit: treatment with anterior vascularized rib grafts, posterior osteotomies and fusion. J Bone Jt Surg Br 72:686–693
15.
Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior inter-body fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39:429–436PubMedCrossRef
16.
Kim DJ, Yun YH, Moon SH, Riew KD (2004) Posterior instrumentation using compressive laminar hooks and anterior inter-body arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine 29(13):275–279CrossRef
17.
Saraph VJ, Bach CM, Krismer M, Wimmer C (2005) Evaluation of spinal fusion using autologous anterior strut grafts and posterior instrumentation for thoracic/thoraco-lumbar kyphosis. Spine 30(14):1594–1601PubMedCrossRef
18.
Talu U, Gogus A, Ozturk C, Hamzaoglu A, Domanic U (2006) The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech 19(8):554–559PubMedCrossRef
19.
Suh KT, Seong YJ, Lee JS (2008) Simultaneous anterior and posterior surgery in the management of tuberculous spondylitis with psoas abscess in patients with neurological deficits. Asian Spine J 2(2):94–101PubMedCrossRef
20.
Chunguang Z, Limin L, Rigao C, Yueming S, Hao L et al (2010) Surgical treatment of kyphosis in children in healed stages of spinal tuberculosis. J Pediatr Orthop 30(3):271–276PubMedCrossRef
21.
El-Sharkawi MM, Said GZ (2012) Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure? Int Orthop 36(2):315–324PubMedCrossRef
22.
Wang Z, Yuan H, Geng G, Shi J, Jin W (2012) Posterior mono-segmental fixation, combined with anterior debridement and strut graft, for treatment of the mono-segmental lumbar spine tuberculosis. Int Orthop 36:325–329PubMedCrossRef
23.
Xiao-bin Wang, Li J, Guo-hua Lü, Wang Bin LuC, Yi-Jun Kang (2012) Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop 36:373–380CrossRef
24.
Oga M, Arizono T, Takasita M et al (1993) Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clin Biol Study Spine 18:1890–1894CrossRef
25.
Ha KY, Chung YG, Ryoo SJ (2004) Adherence and bio-film formation of Staphylococcus epidermis and Mycobacterium tuberculosis on various spinal implants. Spine 29(24):1–6
26.
Benli IT, Acaroğlu E, Akalin S, Kis M, Duman E, Un A (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12(2):224–234PubMed
27.
Jin D, Qu D, Chen J, Zhang H (2004) One-stage anterior inter-body auto grafting and instrumentation in primary surgical management of thoraco-lumbar spinal tuberculosis. Eur Spine J 13(2):114–121PubMedCrossRef
28.
Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S (1976) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19(9):1039–1043CrossRef
29.
Garst RJ (1992) Tuberculosis of the spine: a review of 236 operated cases in an underdeveloped region from 1954 to 1964. J Spinal Disord 5(3):286–300PubMedCrossRef
30.
Campbell PG, Malone J, Yadla S, Maltenfort MG, Harrop JS et al (2010) Early complications related to approach in thoracic and lumbar spine surgery: a single center prospective study. World Neurosurg 73(4):395–401PubMedCrossRef
31.
McDonnell MF, Glassman SD, Dimar JR 2nd, Puno RM, Johnson JR (1996) Perioperative complications of anterior procedures on the spine. J Bone Jt Surg 78(6):839–847
32.
Chiriano J, Abou-Zamzam AM Jr, Urayeneza O, Zhang WW, Cheng W (2009) The role of the vascular surgeon in anterior retroperitoneal spine exposure: preservation of open surgical training. J Vasc Surg 50(1):148–151PubMedCrossRef
33.
Jarrett CD, Heller JG, Tsai L (2009) Anterior exposure of the lumbar spine with and without an “access surgeon”: morbidity analysis of 265 consecutive cases. J Spinal Disord Tech 22(8):559–564PubMedCrossRef
34.
Jain AK, Dhammi IK, Jain S, Mishra P (2010) Kyphosis in spinal tuberculosis–prevention and correction. IJO 44(2):127–136
35.
Tuli SM (2007) Tuberculosis of the spine: a historical review. Clin Orthop Relat Res 460:29–38PubMed
36.
Jain S (2010) Comment on Huang et al. One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 34(5):769–770PubMedCrossRef
37.
Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko KA (2012) Posterior versus anterior surgical approach in combination with debridement, inter-body auto grafting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36:307–313PubMedCrossRef
38.
Moon M-S et al (1986) Harrington rods in treatment of active spinal tuberculosis with kyphosis. J West Pac Orthop Assoc 23:53
39.
Guzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B (2005) Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases. J Neurosurg Spine 3(6):450–458PubMedCrossRef
40.
Lee JS, Moon KP, Kim SJ, Suh KT (2007) Posterior lumbar inter-body fusion and posterior instrumentation in the surgical management of lumbar tuberculous spondylitis. J Bone Jt Surg Br 89(2):210–214CrossRef
41.
Lee SH, Sung JK, Park YM (2006) Single stage transpedicular decompression and posterior instrumentation in the treatment of thoracic and thoraco-lumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19:595–602PubMedCrossRef
42.
Gokce A, Ozturkmen Y, Mutlu S, Caniklioğlu M (2008) Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis. J Spinal Disord Tech 21(7):484–488PubMedCrossRef
43.
Bezer M, Kucukdurmaz F, Guven O (2007) Transpedicular decancellous osteotomy in the treatment of post-tuberculous kyphosis. J Spinal Disord Tech 20:209–215PubMedCrossRef
44.
Kalra KP, Dhar SB, Shetty P, Dhariwal Q (2006) Pedicle subtraction for rigid post tuberculous kyphosis. J Bone Jt Surg Br 88:925–927
45.
Kumar K (1998) Tuberculosis of the spine—natural history of the disease and its judicious management. J West Pac Orthop Assoc 25:1–18
46.
Erturer E, Tezer M, Aydogan M, Mirzanlı C, Ozturk I (2010) The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J 19(12):2209–2215PubMedCrossRef
47.
Rajasekaran S, Vijay K, Shetty AP (2010) Single-stage closing-opening wedge osteotomy of spine to correct severe post-tubercular kyphotic deformities of the spine: a 3-year follow-up of 17 patients. Eur Spine J 19(4):583–592PubMedCrossRef
48.
Wang Y, Zhang Y, Zhang X, Wang Z, Mao K, Chen C, Zheng G, Li G, Wood KB (2009) Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity. Eur Spine J 18(10):1436–1441PubMedCrossRef
49.
Dai LY, Chen WH, Jiang LS (2008) Anterior instrumentation for the treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. Eur Spine J 17(8):1027–1034PubMedCrossRef
50.
Upadhyay SS, Saji MJ, Sell P, Sell B, Hsu LC (1994) Spinal deformity after childhood surgery for tuberculosis of the spine: a comparison of radical surgery and debridement. J Bone Jt Surg Br 76:91–98
Metadata
Title
Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting
Authors
Malhar N. Kumar
Bushan Joseph
Ravikiran Manur
Publication date
01-03-2013
Publisher
Springer-Verlag
Published in
European Spine Journal / Issue 3/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI
https://doi.org/10.1007/s00586-012-2528-0

Other articles of this Issue 3/2013

European Spine Journal 3/2013 Go to the issue

Original Article

Radiological study on disc degeneration of thoracolumbar burst fractures treated by percutaneous pedicle screw fixation

Original Article

Operative treatment of chance injuries in the paediatric population

Original Article

Treatment of spinal epidural compression due to hematological malignancies: a single institution’s retrospective experience

Open Operating Theatre (OOT)

Freehand correction of scoliosis in Rett’s syndrome

Original Article

Application triangular osteosynthesis for vertical unstable sacral fractures

Original Article

Is closed-suction drainage necessary after intradural primary spinal cord tumor surgery?