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European Spine Journal

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01-06-2013 | Original Article

Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis

Authors: Muhammad Asad Qureshi, Ahmed Bilal Khalique, Waseem Afzal, Ibrahim Farooq Pasha, Max Aebi

Published in: European Spine Journal | Special Issue 4/2013

Abstract

Introduction

Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature.

Materials and methods

We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p < 0.001). Seven patients had implant failures and revision surgeries in the modified Hong Kong group. Neurological improvement, pain relief and functional outcome were the same in both groups.

Conclusion

We conclude that pedicle screw fixation with or without a correcting osteotomy should be added in all patients with multilevel thoracolumbar tuberculous spondylitis undergoing radical debridement and anterior column reconstruction.

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Title: Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis
Authors: Muhammad Asad Qureshi
Ahmed Bilal Khalique
Waseem Afzal
Ibrahim Farooq Pasha
Max Aebi
Publication date: 01-06-2013
Publisher: Springer-Verlag
Published in: European Spine Journal / Issue Special Issue 4/2013
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-012-2459-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis

Abstract

Introduction

Materials and methods

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Materials and methods

Conclusion

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