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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(03): 183-189
DOI: 10.1055/s-0039-1698588
Original Article

Clinical Outcome of Single-Stage Decompression and Posterior Stabilization in Thoracolumbar Spinal Tuberculosis

Susanta Kumar Patro
1   Department of Neurosurgery, Ispat General Hospital, Rourkela, Odisha, India
,
Biswaranjan Nayak
2   Department of Neurosurgery, AMRI Hospital, Bhubaneswar, Odisha, India
,
Balappa Holeppagol Krishnamurthy
3   Department of Neurosurgery, Sri Balaji Institute of Neuroscience and Trauma, Vidyanagar, Hubli, Karnataka, India
,
Arun Kumar
4   Department of Neurosurgery, Fortis Hospital, Shalimar Bagh, Delhi, India
,
Debabrata Biswal
5   Department of Neurosurgery, Apollo Hospital, Bhubaneswar, Odisha
,
Prafulla Kumar Sahoo
5   Department of Neurosurgery, Apollo Hospital, Bhubaneswar, Odisha
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Abstract

Background Thoracolumbar spine constitutes the most common site for spinal tuberculosis. Though the treatment of spinal tuberculosis is antitubercular drugs initially, the patient with neurologic weakness warrants definitive surgical procedure of decompression and stabilization. Even though many investigators have reported favorable results with anterior decompression and stabilization surgery, due to the increased morbidity and complications, the posterior-only approach with decompression and stabilization has evolved as the operation of choice in recent time.

Methods All patients aged between 18 and 70 years with clinically and radiologically proven symptomatic thoracolumbar spinal tuberculosis who failed with conservative treatment for 4 weeks or developed neurologic weakness between the treatments are included in this study. All patients were offered decompression and posterior stabilization with transpedicular screws and rods after explaining the above procedure. Clinical outcome was measured by modified Frankel grading; AIS (American Spinal Injury Association impairment score) grade impairment score; and pain assessment done with visual analog scale (VAS) pre- and postoperatively and at 3, 6, and 9 months of interval.

Results The postoperative pain relief, neurologic improvement as per modified Frankel grade, AIS grade, and improvement in erythrocyte sedimentation rate and C-reactive protein were significant as compared with the preoperative status. The surgical interventions thus prove to have adequate relief to the patient and arresting the disease progression. The surgical outcome has very minimal intra- and postoperative complications.

Conclusion Single-stage decompression and posterior stabilization in thoracolumbar spinal tuberculosis is safe, effective, and results in good clinical outcome. The advantages of surgery include thorough debridement, decompression, and achievement of spinal stabilization.

Keywords

tuberculosis - spine - decompression - posterior fixation


Publication History

Article published online:
19 April 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Jain AK. Tuberculosis of spine: Research evidence to treatment guidelines. IJO 2016; 50 (01) 3-9
    PubMedGoogle Scholar
  • 2 Tuli SM. Tuberculosis of the Skeletal System (Bones, Joints, Spine and Bursal Sheaths), 4th edition. Chapter 19. New Delhi: Jaypee Brothers Medical Publishers 2010
  • 3 Jain AK, Dhammi IK. Prashad, Simultaneous anterior decompression and posterior instrumentation of the tuberculosis spine using an anterolateral extrapleural approach. J Bone Joint Br 2008; 90: 1477-1481
    CrossrefPubMedGoogle Scholar
  • 4 Hodgson AR, Stock FE, Fang HS, Ong GB. Anterior spinal fusion: The operative approach and the pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 1960; 48: 172-178
    CrossrefPubMedGoogle Scholar
  • 5 Hee HT, Majd ME, Holt RT. Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Sinal Disord Tech 2002; 15: 149-156
    CrossrefPubMedGoogle Scholar
  • 6 Krodel A, Kruger A, Pfahler M. Anterior debridement, fusion and extra focal stabilization in the treatment of osteomyelitis of spine. J spinal Disord 1999; 8: 304-309
    PubMedGoogle Scholar
  • 7 Fukuta S. et al. Two stage surgical treatment using posterior spinal instrumentation for pyogenic and tuberculous spondylitis. Spine 2003; 28: E302-E308
    CrossrefPubMedGoogle Scholar
  • 8 Moon MS, Woo YK, Lee KS. et al. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spine. Spine 1995; 20: 1910-1916
    CrossrefPubMedGoogle Scholar
  • 9 Lee TC, Lu K, Yang LC, Huang HY, Liang CL. Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early state bone destruction. J Neurosurg 1999; 91 (Suppl. 02) 163-169
    CrossrefPubMedGoogle Scholar
  • 10 Jia Xufeng, Long Miao, Zhou Qingzhong, Ji Yong, Huang Guangping, Zhou Yul, Feng Daxiong. Efficacy of posterior-only decompression, focal clearance, and internal fixation in treatment of thoracic and lumbar tuberculosis. Biomedical Research 2018; 29 (02) 262-267
    PubMedGoogle Scholar
  • 11 Zhong Nanzhe, Kong Jinhai, Sun Zhengwang, Quian Ming, Liu Tielong, Xiao Jianru. One-stage posterior approach in the treatment of consecutive multi-segment thoracic tuberculosis with Kyphosis. Turkish Neurosurgery 2018; 28 (03) 1-8
    PubMedGoogle Scholar
  • 12 Yuliang Dai, Li Yawei, Wang Bing, Lv Guohua. Anterior versus posterior surgery for mono-segmental thoracic spinal tuberculosis: selection of the optimal approach and comparison of outcomes. Int J Clin Exp Med 2017; 10 (07) 10463-10471
    PubMedGoogle Scholar
  • 13 Patidar AB, Mehta RP, Sharma SK, Vyas GB, Singh V, Ramchandra O. Single-stage posterior-only debridement and transpedicular screw fixation for thoracolumbar tuberculosis: a prospective study of twenty cases. J Orthop Allied Sci 2017; 5: 74-79
    CrossrefPubMedGoogle Scholar
  • 14 Alavi SM, Khoshkhoy MM. Pulmonary tuberculosis and diabetes mellitus: Co-existence of both diseases in patients admitted in a teaching hospital in the southwest of Iran. Caspian J Intern Med 2012; 3 (02) 421-424
    PubMedGoogle Scholar
  • 15 Saha Apel Chandra, Kabiraj SnritiKona, Rahman MdRezwanur, Shermin MdShahana, Masud Hasan, Awlad HossainMuhammad. Surgical treatment of thoracolumbar spine tuberculosis by posterior decompression, stabilization with transpedicular screws and rods and fusion. Delta Med Col J 2016; 4 (02) 71-76
    CrossrefPubMedGoogle Scholar
  • 16 Natacha Berkowitz, Adaeze Okorie, Renea Goliath, Naomic Levitt, Wilkinson RobertJ, Oni Tolu. The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting. Diabetes research and clinical practice 138 2018; 16-25
    CrossrefPubMedGoogle Scholar
  • 17 Saha Nabarun, Mukhopadhyay KiranKumar, Garg AnantKumar, Kumar Sanjay, Sarathi SarkarPartha. Comparative study of debridement, fusion and instrumentation via single stage anterior or single stage posterior approach in thoraco-lumbarspinal tuberculosis. International Journal of Orthopaedics Sciences 2017; 3 (02) 901-990
    CrossrefPubMedGoogle Scholar
  • 18 Prabhat Vinay, Kumar Ramesh, Sahu Harekrushna, Boruah Tankeshwar, Palak Jay, Dagar Ashish. Single stage transpedicular decompression, fixation and deformity correction in tuberculosis of dorsal and lumbar spine. IOSR Journal of Dental and Medical Sciences Aug 2017; 16 (08) 92-97
    PubMedGoogle Scholar
  • 19 Liu Zhili, Liu Ziaming, Peng Aifeng, Long Xinhua, Yang Dong, Huang Shanhu. One-stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. ScientificWorldJournal 2014; 2014: 137106
    PubMedGoogle Scholar
  • 20 Luo Chengke, Wang Xiyang, Wu Ping, Ge Lie, Zhang Hongqi, Hu Jianzhong. Single-stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. The Spine Journal 2016; 16 (02) 154-162
    CrossrefPubMedGoogle Scholar
  • 21 Hao Zeng. et al. One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases. BMC Musculoskeletal Disorders 2015; 16: 186
    CrossrefPubMedGoogle Scholar