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DOI: 10.4103/ajns.AJNS_52_20
Outcome analysis of anterior reconstruction with rib grafts in tuberculosis of the thoracic spine
Introduction: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. Subjects and Methods: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. Results: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. Discussion: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The “Versatile approach” used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. Conclusion: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.
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Publikationsverlauf
Eingereicht: 09. Februar 2020
Angenommen: 07. Mai 2020
Artikel online veröffentlicht:
16. August 2022
© 2020. Asian Congress of Neurological Surgeons. 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 Pott P, Earle J. The Chirurgical Works of Percivall Pott. J. Johnson; 1808.
- 2 Tuli SM. Tuberculous osteomyelitis. In: Tuberculosis of the Skeletal System. 3rd ed. New Delhi: Jaypee Brothers Medical Publishers Ltd.; 2004. p. 174-83.
- 3 Srivastava SK, Aggarwal RA, Bhosale SK, Roy K, Nemade PS. The versatile approach: A novel single incision combined with anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine. Asian Spine J 2017;11:294-304.
- 4 Hodgson AR, Stock FE. Anterior spine fusion for the treatment of tuberculosis of the spine: The operative findings and results of treatment in the first 100 cases. Bone Joint J Surg 1960;42:295-310.
- 5 Upadhyay SS, Saji MJ, Yau AC. Duration of anti-tuberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis. Spine 1996;21:1898-903.
- 6 Zhang HQ, Lin MZ, Shen KY, Ge L, Li JS, Tang MX, et al. Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Arch Orthop Trauma Surg 2012;132:751-7.
- 7 Louw JA. Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion. J Bone Joint Surg Br 1990;72:686-93.
- 8 Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH. Posterior instrumentation and anterior inter-body fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine (Phila Pa 1976) 1995;20:1910-6.
- 9 Chan K, Resnick D, Pathria M, Jacobson J. Pelvic instability after bone graft harvesting from posterior iliac crest: Report of nine patients. Skeletal Radiol 2001;30:278-81.
- 10 Porchet F, Jaques B. Unusual complications at iliac crest bone graft donor site: Experience with two cases. Neurosurgery 1996;39:856-9.
- 11 Hamad MM, Majeed SA. Incisional hernia through iliac crest defects. A report of three cases with a review of the literature. Arch Orthop Trauma Surg 1989;108:383-5.
- 12 Tuli SM. Results of treatment of spinal tuberculosis by “middle-path” regime. J Bone Joint Surg Br 1975;57:13-23.
- 13 Rajasekaran S, Kanna RM, Shetty AP. Pathophysiology and treatment of spinal tuberculosis. JBJS Rev 2014;2. pii: 01874474-201409000-00004.
- 14 Banwart JC, Asher MA, Hassanein RS. Iliac crest bone graft harvest donor site morbidity. A statistical evaluation. Spine (Phila Pa 1976) 1995;20:1055-60.