The Improvement in Kyphotic Angle after Anterior Decompression and Cage Placement in Tuberculosis of Thoraco-lumbar Spine
Keywords:
Caries spine, Titanium mesh cage, Anterior decompression, kyphotic angleAbstract
Background: Musculoskeletal Tuberculosis is a rare form of TB comprising only 3% of all Tuberculosis patients. The commonest and most dangerous form of Tuberculosis, Spinal Tuberculosis accounts for 50% of all cases of musculoskeletal Tuberculosis. The anterior decompression with cage alone without added instrumentation with bone graft is cost effective as compared to added instrumentation in patients of third world countries.
Objective: To determine the improvement in terms of mean change in postoperative kyphotic angle after anterior decompression and cage placement with bone graft in tuberculosis of Thoraco-lumbar spine.
Materials and Methods: The Quasi Experimental study was conducted in the Department of Orthopaedics and Spine of Ghurki Trust Teaching Hospital, Lahore from 1st May 2014 to 31st Apr 2016.60 patients who qualify the inclusion criteria were included. All patients underwent anterior decompression and placement of Inter body Titanium Mesh Cage with packed bone graft. Pre, Post-operative and follow-up lateral view x-rays were taken to check and record the post operative change in kyphotic angle as well as loss in follow up. All the patients were followed for at least 1 year. Boston brace was applied for at least 6 months. Data was analyzed using SPSS 17.0
Results: There were 38 (63.3%) males and 22 (36.7%) females. The patients aged between 15 – 30 years were 32 (53.3%), those between aged 31 – 45 years were 15 (25%) and between 46 – 60 years there were 13 (21.7%). There were 10 (16.6%) patients with 0 – 10 degree improvement, 36 (60%) patients with 11 – 20 degree improve-ment and 14 (23.4%) patients with 21 – 30 degree improvement. Paired t-test result for change in angle is p = 0.000 which is statistically significant.
Conclusion: Anterior decompression with Standalone Titanium mesh cage and bone graft in patients suffering from caries spine showed immediate post operative improvement in kyphotic angle as well as no significant loss in correction in follow-up.
References
2. Rahman O, Ahmad S, Hussain T. Anterior surgical interventions in spinal tuberculosis. J Coll Physician Surg Pak. 2009; 19 (8): 500-505.
3. Camillo FX, Infections of the spine. In; Canale S T, Baety J H editors. Campbell's Operative Orthopaedic 12th Edition. Pennsylvania: Mosby Elsevier, 2013: 1965-1991.
4. Garg AK, Garg P, Ayan S, et al. Anterior decompress-ion and anterior instrumentation of tuberculosis of cer-vicothoracic spine by cervicomanubrial approach. Al-Ameen J Med Sci. 2012; 5 (2): 124-131.
5. Wang B, LG, Liu W, et al. Anterior radical debride-ment and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: Minimium five year follow-up. Turk Neurosurg. 2011; 21 (4): 575-581.
6. Uchida K, Nakajina H, Yayama T, et al. Vertebropla-sty-augmented short-segment posterior fixation of oste-oporotic vertebral collapse with neurological deficit in the thoracolumbar spine: copmparisions with posterior surgery without vertebroplasty and anterior surgery. J Neurosurg Spine November, 2010; 13: 612-621.
7. Abdel Rahman Hafez, and Mona Fattou, One-Stage Posterior Instrumentation and Fusion for the Treatment of Tuberculous Spondylodiscitis of Dorsal and Lumbar Spine. Journal of American Science, 2012; 8 (9): 85-90. 8. B Jadav, M Prabhakar. Primary Posterior Fixation for Tuberculosis of the Spine. The Internet Journal of Orth-opedic Surgery, 2007; Volume 10 Number 1. 9. Jha DK, Singh R, Pant I. Transpedicular Surgical De-compression of Dorsal Spinal Tuberculosis (Pott’s Dis-ease) with Vertebral Collapse without Fixation. Neuro-surg. 2016; 1: 2.
10. Stefan Endres, Axel Wilke ,Posterior interbody grafting and instrumentation for spondylodiscitis. Journal of Orthopaedic Surgery, 2012; 20 (1): 1-6. 11. Thaker RA, Gautam VK. Study of Vertebral Body Re-placement with Reconstruction Spinal Cages in Dorso-lumbar Traumatic and Koch’s Spine. Asian Spine Jou-rnal. 2014; 8 (6): 786-792. doi:10.4184/asj.2014.8.6.786.
12. Wang B. et al: Anterior Radical Debridement and Re-construction Using Titanium Mesh Cage for the Surgi-cal Treatment of Thoracic and Thoracolumbar SpinalTuberculosis: Minimium Five – Year Follow. Turkish Neurosurgery, 2011, Vol. 21, No. 4: 575-581.
13. Refae HH. One – stage posterior approach for the treat-ment of tuberculous spondylitis with kyphosis. Egypt Orthop J. 2015; 50: 223-6.
14. Ramírez Elio, Ochoa Marcelo, Ordoñez Fausto. Surgi-cal treatment of spinal tuberculosis by anterior appro-ach. Coluna/Columna [Internet], 2013 Dec. [cited 2016 Aug 13]; 12 (4): 308-311.
15. Xiongjie Shen et al. Surgical treatment of selected pati-ents with multilevel contiguous thoracolumbar spinal
tuberculosis by only posterior instrumentation without any bone fusion. Int J Clin Exp Med. 2015; 8 (10): 18611-18619. 16. Liljenqvist, U., Lerner, T., Bullmann, V. et al. Eur Spi-ne J. 2003; 12: 606.
17. Farzad Omidi – Kashani, Ebrahim G. Hasankhani, Mohamed H. Ebrahimzadeh, Anterior spinal surgery alone in the surgical treatment of thoracolumbar spinal tuberculosis: a prospective study, MJIRI, Dec. 2011; Vol. 25, No. 4: pp. 209-215.
Downloads
Published
Issue
Section
License
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).
