The outcome of Posterio-lateral Decompression and Transpedicle Fixation for Thoracic Spine Tuberculosis
DOI:
https://doi.org/10.36552/pjns.v25i4.612Keywords:
Posterolateral Decompression, Thoracic Spine, Spine Tuberculosis, Trans-pedicle FixationAbstract
Objective: The study assessed the outcome of posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis.
Materials and Methods: An observational, cross-sectional study was conducted at the Department of Neurosurgery, Lady Reading Hospital, Peshawar. All those patients who had undergone posterio-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis were included. Both genders with ages more than 14 years were included in our study. Ethical committee approval was taken. Pre-designed proforma was used for data entry. Patients’ data were analysed through SPSS software.
Results: A total of 31 patients with tuberculous spondylodiscitis were studied. The age ranged from 15 – 57 years with a mean of 37.74 ± 10.07 years. Most of the patients with thoracic TB were male 54.8% (17/31). Pain improved in all the patients and neurology improved in most of the cases. The dural tear was in one patient and one patient had a wound infection. There was no mortality.
Conclusions: We conclude from the study that posterior-lateral decompression and trans-pedicle fixation for thoracic spine tuberculosis is a safe procedure. It has good results in terms of pain relief and neurological improvement. This procedure has an acceptable complications rate. Therefore, it can be considered as a better alternative to other surgical procedures for thoracic spine tuberculosis.
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26. Sun QP, Xiao J, Pi HL, He JW, Wu QH. Debridement and bone grafting with internal fixation via anterior approach for the treatment of tuberculosis of lower cervical vertebrae. Zhongguo Gu Shang,
2020; 25; 33 (2): 149-53.
27. Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res. 2020; 15: 99.
28. Yadav G, Kandwal P, Arora SS. Short-term outcome of lamina-sparing decompression in thoracolumbar spinal tuberculosis. J Neurosurg Spine, 2020 Mar. 20: 1-8.
29. Yin XH, Liu ZK, He BR, Ding J. Hao DJ. Single posterior surgical management for lumbosacral tuberculosis: titanium mesh versus iliac bone graft. Medicine (Baltimore), 2017; 96 (51): e9449.
30. Shi S, Ying X, Zheng Q, Zhu B, Jin Y, Shen J. Application of cortical bone trajectory screws in elderly patients with lumbar spinal tuberculosis. World Neurosurg. 2018; S1878–8750 (18): 31122–31127.
31. Thakur K, Das M, Dooley KE, Gupta A. The global neurological burden of tuberculosis. Semin Neurol. 2018; 38 (2): 226–237.
32. Gao Y, Ou Y, Deng Q, He B, Du X, Li J. Comparison between titanium mesh and autogenous iliac bone graft to restore vertebral height through posterior approach for the treatment of thoracic and lumbar spinal tuberculosis. PLoS One, 2017; 12 (4): e0175567.
33. Cui X, Zhang Z, Ding Z. Morphometric study of transverse process of thoracic and lumbar vertebra and its significance. Chin J Clin Anat. 2015; 23 (5): 474–476.
34. Zhang H, Zeng K, Yin X, Huang J, Tang M, Guo C. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surg Res. 2015; 10: 150.
35. Wu W, Lyu J, Liu X, Luo F, Hou TY, Zhou Q et al. Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study. World Neurosurgery, 2018; 110: e842-e850.
36. Pola E, Rossi B, Nasto LA, Colangelo D, Logroscino CA. Surgical treatment of tuberculous spondylodiscitis. European Review for Medical and Pharmacological Sciences, 2012; 1 (2): 79-85.
37. Yin H, Wang K, Gao Y, Zhang Y, Liu W, Song Y et al. Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients. J Orthop Surg Res. 2018; 13: 312.
38. Liu Z, Wang X, Xu Z, Zeng H, Zhang P, Peng W
et al. Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin
Neurol Neurosurg. 2016; 141: 111-6.
39. Xu Z, Wang X, Shen X, Luo C, Zeng H, Zhang P, et al. Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Spinal Cord. 2015; 53 (6): 482-7.
2. Moon MS. Tuberculosis of Spine: Current Views in Diagnosis and Management. Asian Spine J. 2014; 8 (1): 97–111.
3. Abuaku BK, Tan H, Chen M, Huang X. A comparative analysis of tuberculosis treatment success between Hunan Province of China and Eastern Ghana. Med Princ Pract. 2010; 19: 451-456.
4. Pigrau-Serrallach Carlos, Rodríguez-Pardo Dolores. Bone and joint tuberculosis. European Spine Journal, 2012; 22 (S4): 556–566.
5. Nagashima H, Yamane K, Nishi T, Hideki N, Teshima R. Recent trends in spinal infections: retrospective analysis of patients treated during
the past 50 years. Int Orthop. 2010; 34: 395-399.
6. Ekinci S, Agilli M, Ekinci GH, Ersen O. Treatment of thoracic or lumbar spinal tuberculosis complicated by resultant listhesis at the involved segment. Clin Neurol Neurosurg. 2015; 128: 131–132.
7. Rasjido LV, Vargas MJ, Fajre LE, Luciardi HL. Pott disease in thoracic spine. Medicina (B Aires), 2014; 74: 391.
8. Liu Z, Wang J, Chen G-Z, Li W-W, Wu Y-Q, Xiao X, et al. Clinical characteristics of 1378 inpatients with spinal tuberculosis in general hospitals in South-Central China. Biomed Res Int. 2019; 2019: 11.
9. Sai-Kiran NA, Vaishya S, Kale SS, Sharma BS, Mahapatra AK. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine, 2007; 6: 320–326.
10. Swanson AN, Pappou IP, Cammisa FP, Giradi FP. Chronic infections of the spine: surgical indications and treatments. Clin Orthop Relat Res. 2006; 444: 100-106.
11. Zhang P, Wei P, Wang X, Luo C, Xu Z, Hao Z, et al. Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. Br J Neurosurg. 2016: 1–6.
12. Madan MS, Sudhir KM, Gopal CS, Sunil KD. Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis: A Retrospective Study. Journal of Spinal Disorders & Techniques, 2012; 25 (7): E217-E223.
13. D’souza, Areena R, Bibhudendu M, Murari L, Kalidutta D. Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB. Clinical Spine Surgery, 2017; 30 (10): E1426-E1433.
14. Yin XH, Liu ZK, He BR, Ding J. Hao DJ. Single posterior surgical management for lumbosacral tuberculosis: titanium mesh versus iliac bone graft. Medicine (Baltimore), 2017; 96 (51): e9449.
15. Liu Z, Zhang P, Zeng H, Xu Z, Wang X. A comparative study of single-stage transpedicular debridement, fusion, and posterior long-segment versus short-segment fixation for the treatment of thoracolumbar spinal tuberculosis in adults: minimum five-year follow-up outcomes. Int
Orthop. 2018; 42 (4): 1–8.
16. He Q, Xu J. Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis. Int Orthop. 2012; 36: 345–51.
17. Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q. Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg. 2012; 132: 1717–23.
18. Song JF, Jing ZZ, Chen B, Ai Z, Hu W. One-stage anterolateral surgical treatment for lumbosacral segment tuberculosis. Int Orthop. 2012; 36: 339–44.
19. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br. 2010; 2 (9): 905–913. Doi: 10.1302/0301-620X.92B7.24668.
20. Wang B, Kong L, Zhu Z, Gao W, Guo H, Wang X,
et al. Recurrent complex spinal tuberculosis accompanied by sinus tract formation: causes of recurrence and clinical treatments. Sci Rep. 2018; 8: 6933.
21. Lan X, Liu XM, Ge BF. Debridement and bone grafting with internal fixation via anterior approach for treatment of cervicothoracic tuberculosis. Int Sur. 2011; 96: 358–362. Doi: 10.9738/CC62.1.
22. Moon MS. Tuberculosis of spine: contemporary thoughts on current issues and perspective views. Curr Orthop. 2007; 21: 364–379.
23. Zhong W, Liang X, Tang K, Luo X, Quan Z. Transverse process strut and titanium mesh cages in the stability reconstruction of thoracic single segment tuberculosis: a retrospective single-center cohort study. BMC Musculoskelet Disord. 2020; 21: 172.
24. Jin D, Qu D, Chen J, Zhang H. One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J. 2004; 13 (2): 114-21.
25. Cui X, Ma YZ, Chen X, Cai XJ, Li HW, Bai YB. Outcomes of Different Surgical Procedures in the Treatment of Spinal Tuberculosis in Adults. Med Princ Pract. 2013; 22: 346-350.
26. Sun QP, Xiao J, Pi HL, He JW, Wu QH. Debridement and bone grafting with internal fixation via anterior approach for the treatment of tuberculosis of lower cervical vertebrae. Zhongguo Gu Shang,
2020; 25; 33 (2): 149-53.
27. Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res. 2020; 15: 99.
28. Yadav G, Kandwal P, Arora SS. Short-term outcome of lamina-sparing decompression in thoracolumbar spinal tuberculosis. J Neurosurg Spine, 2020 Mar. 20: 1-8.
29. Yin XH, Liu ZK, He BR, Ding J. Hao DJ. Single posterior surgical management for lumbosacral tuberculosis: titanium mesh versus iliac bone graft. Medicine (Baltimore), 2017; 96 (51): e9449.
30. Shi S, Ying X, Zheng Q, Zhu B, Jin Y, Shen J. Application of cortical bone trajectory screws in elderly patients with lumbar spinal tuberculosis. World Neurosurg. 2018; S1878–8750 (18): 31122–31127.
31. Thakur K, Das M, Dooley KE, Gupta A. The global neurological burden of tuberculosis. Semin Neurol. 2018; 38 (2): 226–237.
32. Gao Y, Ou Y, Deng Q, He B, Du X, Li J. Comparison between titanium mesh and autogenous iliac bone graft to restore vertebral height through posterior approach for the treatment of thoracic and lumbar spinal tuberculosis. PLoS One, 2017; 12 (4): e0175567.
33. Cui X, Zhang Z, Ding Z. Morphometric study of transverse process of thoracic and lumbar vertebra and its significance. Chin J Clin Anat. 2015; 23 (5): 474–476.
34. Zhang H, Zeng K, Yin X, Huang J, Tang M, Guo C. Debridement, internal fixation, and reconstruction using titanium mesh for the surgical treatment of thoracic and lumbar spinal tuberculosis via a posterior-only approach: a 4-year follow-up of 28 patients. J Orthop Surg Res. 2015; 10: 150.
35. Wu W, Lyu J, Liu X, Luo F, Hou TY, Zhou Q et al. Surgical Treatment of Thoracic Spinal Tuberculosis: A Multicenter Retrospective Study. World Neurosurgery, 2018; 110: e842-e850.
36. Pola E, Rossi B, Nasto LA, Colangelo D, Logroscino CA. Surgical treatment of tuberculous spondylodiscitis. European Review for Medical and Pharmacological Sciences, 2012; 1 (2): 79-85.
37. Yin H, Wang K, Gao Y, Zhang Y, Liu W, Song Y et al. Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients. J Orthop Surg Res. 2018; 13: 312.
38. Liu Z, Wang X, Xu Z, Zeng H, Zhang P, Peng W
et al. Two approaches for treating upper thoracic spinal tuberculosis with neurological deficits in the elderly: A retrospective case-control study. Clin
Neurol Neurosurg. 2016; 141: 111-6.
39. Xu Z, Wang X, Shen X, Luo C, Zeng H, Zhang P, et al. Posterior only versus combined posterior and anterior approaches for lower lumbar tuberculous spondylitis with neurological deficits in the aged. Spinal Cord. 2015; 53 (6): 482-7.
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