ABSTRACT
Spinal tuberculosis accounts for nearly half of all cases of musculoskeletal tuberculosis. It is primarily a medical disease and treatment consists of a multidrug regimen for 9-12 months. Surgery is reserved for select cases of progressive deformity or where neurological deficit is not improved by anti-tubercular treatment. Technology refinements and improved surgical expertise have improved the operative treatment of spinal tuberculosis. The infected spine can be approached anteriorly or posteriorly, in a minimally invasive way. We review the various surgical techniques used in the management of spinal tuberculosis with focus on their indications and contraindications.
Subject(s)
Congenital Abnormalities , Spine , Tuberculosis , Tuberculosis, SpinalABSTRACT
Introdução: A abordagem anterior para o tratamento da escoliose torácica tem sido apresentada como uma opção de tratamento. Objetivo: Este é um estudo retrospectivo de um banco de dados prospectivo (Scolisoft)(1), demonstrando o resultado da instrumentação anterior em pacientes com escoliose idiopática do adolescente (tipo 1 de Lenke) que foram tratados por meio cirúrgico. Material e métodos: Doze pacientes com escoliose idiopática do tipo 1 de Lenke foram submetidos a instrumentação anterior pelo mesmo cirurgião e foram seguidos por um período mínimo de cinco anos. As variáveis avaliadas incluem: correção sagital e coronal, distância da vértebra apical a linha média, rotação da vértebra apical, número de vértebras instrumentadas e variáveis funcionais por meio do questionário SRS-22(2). Resultados: Os pacientes foram seguidos por um período que variou de cinco anos a cinco anos e nove meses (média: 65.25 ± 3.05 meses). O valor médio da medida do ângulo de Cobb no plano frontal foi de 51° ± 13.4 no período pré-operatório, de 14.53° ± 10.6 no pós-operatório e de 21.76° ± 10.13 na avaliação tardia. A porcentagem média de correção da curva escoliótica no plano frontal foi de 72.71 ± 19.69% no pré-operatório inicial e na avaliação tardia, de 57.59 ± 17.92%. A média da cifose torácica (T4-T12) foi de 22.07 ± 10.07° no período pós-operatório imediato e 23.30 ± 9.24° no período pós-operatório tardio. A translação da vértebra apical foi de 53.7 ± 12.1 mm no período pré-operatório, 9.78 ± 9.26 mm no período pós-operatório imediato e 10.41 ± 6.26 mm na avaliação tardia. A rotação da vértebra apical, avaliada pelo método de Nash-Moe(3), foi de 1.5 ± 0.76 no período pré-operatório, 0.16 ± 0.37 no período pós-operatório imediato e 0.21 ± 0.44 na avaliação tardia. O número médio de vértebras instrumentadas foi de 7.69 ± 1.38. Na avaliação funcional (SRS-22)(2) os pacientes tiveram um escore médio de 4.1 ± 0.61 para função, de 4 ± 0.77 para dor, de 3.9 ± 0.79 para função mental, de 4.3 ± 0.66 para satisfação com o resultado cirúrgico e de 4.3 ± 0.75 para auto-imagem. Conclusão: A correção anterior da escoliose torácica é um método alternativo de tratamento cirúrgico que possui a vantagem da realização de menor área de artrodese, preservando a e correção apresenta a desvantagem da necessidade da realização de toracotomia e a comorbidade inerente à técnica.
ABSTRACT
STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.
Subject(s)
Female , Humans , Bone Density , Decompression , Follow-Up Studies , Fractures, Compression , Kyphosis , Mortality , Operative Time , Pain, Intractable , Retrospective Studies , SpineABSTRACT
STUDY DESIGN: A retrospective study OBJECTIVES: To evaluate the clinical and radiological results of anterior decompression and instrumentation for delayed vertebral body collapse in neurologically compromised osteoporotic compression fractures. LITERATURE REVIEW SUMMARY: Indications for an operation in delayed vertebral body collapse, following osteoporotic compression fractures, are intractable pain, progressive kyphosis and neurological deficits. The options for an operation are anterior, posterior and combined anterior and posterior approaches. Posterior surgery may need some degree of destruction of intact posterior elements. Combined anterior and posterior surgery increases the morbidity and mortality due to increased operative time and blood loss. Therefore, a one stage anterior surgery is a reasonable choice. MATERIALS AND METHODS: Between June 1989 and May 2003, seven cases of delayed vertebral body collapse, with neurological deficit, were treated using anterior decompression and anterior Kaneda instrumentation. All the cases were female, with a mean age of 67, ranging from 57 to 77 years. The average follow up period was 3.4, ranging from 1 to 13 years. One patient had a history of steroid medication. The operation time, intraoperative blood loss and bone mineral density were retrospectively reviewed. The changes in the kyphotic angle, preoperatively, postoperatively and on the last follow-up plain lateral radiograph were measured. The clinical results were evaluated based on a modified Frankel grading and visual analogue scale RESULTS: The average kyphotic angles preoperatively, postoperatively and at the last follow up were 29 degrees(25~47 degrees), 14 degrees(6~20 degrees) and 19 degrees(10~27 degrees), respectively. In all cases, the preoperative neurological deficits were improved by more than one degree in the Frankel grading at the final follow up. The mean operation time, blood loss and mean bone mineral density were 3.2 hours, 1514ml and T: -3.51, respectively. The values from the visual analogue scale preoperatively and at the last follow up were 7.0 and 0.5, respectively. CONCLUSIONS: Anterior decompression and instrumentation provides effective neurological decompression and stabilization of the spine by supporting the deficient anterior column in delayed vertebral body collapse.
Subject(s)
Female , Humans , Bone Density , Decompression , Follow-Up Studies , Fractures, Compression , Kyphosis , Mortality , Operative Time , Pain, Intractable , Retrospective Studies , SpineABSTRACT
STUDY DESIGN: Thirty-eight patients with thoracolumbar spinal tuberculosis were evaluated according to the surgical treatment method, either a one or two stage anterior debridement, with anterior or posterior instrumentation, respectively. PURPOSE: The aim of this study was to compare the effects of the one stage anterior debridement, with anterior instrumentation, to the two stage anterior debridement, with posterior instrumentation MATERIALS AND METHODS: Thirty-eight patients, with tuberculous spine, were divided into two groups depending on the surgical method. One group consisted of 21 patients treated with anterior debridement combined with anterior instrumentation, and the other group consisted of 17 patients treated by a two stage operation of anterior debridement combined with posterior instrumentation. The clinical outcomes were evaluated from the hematological laboratory findings, bone union in radiographs, change of kyphotic angle, duration of hospital stay and the medical cost during hospitalization. RESULTS: There were no recurrences of infection in either group and bone union was obtained within 6 months of the operation for all cases in both groups. The preoperative, postoperative and final follow-up kyphotic angle in the two groups were 18/20, 7/9 and 10/11 degrees, respectively. There was no significant difference in the decrease of the kyphotic angle between the two groups (p>0.05). However, group I was superior to group II in relation to the duration of hospital stay and the medical cost. CONCLUSION: We concluded that the one stage operation was the better of the operative methods for the treatment of active tuberculous spondylitis in a thoracolumbar spine.
Subject(s)
Humans , Debridement , Follow-Up Studies , Hospitalization , Length of Stay , Recurrence , Spine , Spondylitis , Tuberculosis, SpinalABSTRACT
Tow surgically treated cases of thoracic tuberculous spondylitis with multievel involvement are presented. Radical debridement produced large deficit in the anterior structures and spinal instability. A reconstruction with mesh cylinder graft and combined anterior instrumentation surgery in one stage operation. Anterior Instrumentation provided immediate stability and protected against development of kyphotic deformity. There was no persistence or recurrence of infection after surgery. The average length of follow up was 24month including 12month, 18month course of chemotherapy.
Subject(s)
Congenital Abnormalities , Debridement , Drug Therapy , Follow-Up Studies , Recurrence , Spondylitis , TransplantsABSTRACT
OBJECTIVES: We performed anterior spinal fusion and instrumentation in treatment of spinal tuberculosis. The clinical results of this operation and metal-related complications were evaluated to determine the rationale of anterior instrumentation in active tuberculous lesion. METHODS: From July 1989 to February 1993, we treated twenty-one patients with spinal tuberculosis by radical resection of the tuberculous lesion and bone grafting, followed by anterior instrumentation using Zielke rod system. The changes in spinal deformity were measured from lateral spinal radiographs obtained preoperatively and postoperatively at 3 months, 6 months, 1 year, 2 years and final follow-up. The recurrence of infection and possible complications were also observed clinically and radiologically. RESULTS: The mean kyphotic angle was decreased preoperatively from 21 degrees to 16 degrees at final follow-up in patients with thoracolumbar tuberculous lesions. The mean deformity angle was corrected 7 degrees in thoracolumbar tuberculosis and 12 degrees in lumbar tuberculosis compared with the preoperative deformity angle. There was not any persistence or recurrence of infection possibly related to the instrumentation. All patients were allowed early ambulation with the aid of a light brace. CONCLUSION: The clinical and radiological results suggested that the anterior instrumentation seemed to be one of the rational approaches for providing immediate stability in treating severe spinal tuberculosis without any significant risk of persistence or recurrence of infection.
Subject(s)
Humans , Bone Transplantation , Braces , Congenital Abnormalities , Early Ambulation , Follow-Up Studies , Recurrence , Spinal Fusion , Tuberculosis , Tuberculosis, SpinalABSTRACT
With improvement of anterior fixation devices, anterior instrumentation-fusion in treatment of thoracolumbar fracture becomes as effective as posterior interbody fusion which has mainly been used up to now. Also, computerized tomography enables us to diagnose the spinal fracture accurately including retropulsive bony fragment and degree of narrowing of spinal canal. We analyzed 18 cases which were treated with anterior interbody fixation in thoracolumbar fracture from Mar. 1977 to Oct. 1986 in Orthopaedic dept. of National Medical Center. The results were as follows ; 1. The mechanism of injury involved falling down in 7 cases, traffic accident 5 cases, and miner injury in 4 cases. 2. The clsssification of fracture by Denis method was compression fracture in 4 cases, bursting fracture in 11 cases, Seat-belt injury in 1 case, Fx-dislocation in 2 cases. 3. The methods of internal fixation were iliac bone graft only in 8 cases, anterior Harrington rod in 2 cases, Webb implant in 6 cases, and Zielke rod in 2 cases. 4. The average preoperative kyphotic angulation was 19.5(range 10 to 22) and immediate postoperative angulation was 10.1(range 2–16). The correction rate was 48%, and the loss of correction was 2.8(range 2–13). The final correction rate was 38.1% with implants, 29.1% without implants. 5. Early operation can get better neurologic recovery. 6. Firm and stsble fixation device is needed.