Surgical Outcome & Cost Analysis of Single Stage Anterior Decompression and Cage Fixation in Patients with Thoracic and Lumbar Tuberculous Spondylitis: A Single Centre Experience Over Six – Years with Comprehensive Literature Review
Objective: For Tuberculous spondylitis (TS) the optimal mode of management for extensive tuberculous spondylitis is still a subject of debate. We determined the outcome for single stage anterior decompression and cage fixation for dorso-lumbar TS.
Material and Methods: This prospective study was conducted between 2012 and 2018. Worsening or new onset neurological deficit, increasing deformity, large paraspinal abscess and those not responding to anti-tuberculous drug therapy were included. Patients with severe comorbidities (> ASA class III) and recurrent cases were excluded. Demographics, clinical features, radiological characteristics, intraoperative details, postoperative complications and follow-up condition were recorded.
Results: One patient with mean age of 45.6 ± 14.9 years with 17 (54.8%) males and 14 (45.2%) females. Mean symptoms duration was 71.9 ± 29.4 days. 41.9% had spasticity & 25.8% had sphincter dysfunction on presentation. Half (48%) of patients had a Frankel grade 3 or less bilaterally. Mean length of the procedure was 137.4 ± 19.9 minutes. 19.4% (n = 6) had postoperative pulmonary complications, 16.1% (n = 5) wound infection, 9.7% (n = 3) had worsening of neurologic deficit and one (3.2%) remained static. Graft extrusion and cage subsidence were noted in one (3.2%) patient each. Favorable outcome was observed in 83.9% (n = 26) while 16.1% (n = 5) had unfavorable outcome. Mean out-of-pocket cost was 164677.4 ± 11469.9 rupees (USD: 1187 approx).
Conclusion: Timely spinal decompression with stabilization at the onset of the Pott’s disease in patients who fulfil the criteria as surgical candidates carries a promising outcome.
2. Gautam MP, Karki P, Rijal S, Singh R. Pott's spine and paraplegia. JNMA J Nepal Med Assoc. 2005; 44 (159): 106-15.
3. A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg Br. 1998; 80 (3): 456-62.
4. Hodgson AR, Stock FE. Anterior spinal fusion a preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg. 1956; 44 (185): 266-75.
5. Ozdemir HM, Us AK, Ogun T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976). 2003; 28 (5): 474-9.
6. Dai LY, Jiang LS, Wang W, Cui YM. () Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine (Phila Pa 1976); 2005; 30 (20): 2342-9.
7. Li M, Du J, Meng H, Wang Z, Luo Z. One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. Spine. 2011; J 11 (8): 726-33.
8. Muheremu A, Niu X, Wu Z, Tian W. () Study on anterior and posterior approaches for spinal tuberculosis: a meta-analysis. Eur J Orthop Surg Traumatol 25 Suppl. 2015; 1: S69-76.
9. Zhang H, Guo Q, Guo C, et al. A medium-term follow-up of adult lumbar tuberculosis treating with 3 surgical approaches. Medicine, 2017; 96 (45): e8574.
10. Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal tuberculosis: diagnosis and management. Asian Spine J. 2012; 6 (4): 294-308.
11. Khoo LT, Mikawa K, Fessler RG. () A surgical revisitation of Pott distemper of the spine. Spine J. 2003; 3 (2): 130-45.
12. Wang WJ, Chen WK, Yan YG, Yao NZ, Wang C. Application of anterior debridement and reconstruction with anatomical screw-plate fixation for lumbosacral tuberculosis: A 2-year-plus follow-up. Medicine, 2017; 96 (26): e7103.
13. Tuli SM. Historical aspects of Pott's disease (spinal tuberculosis) management. Eur Spine J 22 Suppl. 2013; 4: 529-38.
14. Tuli SM. Tuberculosis of the spine: a historical review. Clin Orthop Relat Res. 2007; 460: 29-38.
15. Pola E, Rossi B, Nasto LA, Colangelo D, Logroscino CA. Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci 2012; 16 Suppl. 2: 79-85.
16. Patankar AP. Tuberculosis of spine: An experience of 30 cases over two years. Asian J Neurosurg. 2016; 11 (3): 226-31.
17. Meena S, Mittal S, Chowdhary B. Spinal tuberculosis: Which is the best surgical approach? Medical Principles and Practice, 2014; 23 (1): 96-7.
18. Liu J, Wan L, Long X, Huang S, Dai M, Liu Z. Efficacy and safety of posterior versus combined posterior and anterior approach for the treatment of spinal tuberculosis: A meta-analysis. World Neurosurg. 2015; 83 (6): 1157-65.
19. Jin W, Wang Q, Wang Z, Geng G. Complete debridement for treatment of thoracolumbar spinal tuberculosis: a clinical curative effect observation. Spine J. 2014; 14 (6): 964-70.
20. Cheng Z, Wang J, Zheng Q, Wu Y, Guo X. Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis. Medicine, 2015; 94 (14): e721.
21. Fisahn C, Alonso F, Hasan GA, et al. Trends in spinal Ssrgery for Pott's Disease (2000-2016): An Overview and Bbbliometric study. Global Spine J. 2017; 7(8): 821-8.
22. Cavusoglu H, Kaya RA, Turkmenoglu ON, Tuncer C, Colak I, Aydin Y. A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis. J Neurosurg Spine, 2008; 8 (1): 30-8.
23. Cheung WY, Luk KD. Clinical and radiological outcomes after conservative treatment of TB spondylitis: is the 15 years' follow-up in the MRC study long enough? Eur Spine J. 2013; 22 Suppl. 4: 594-602.
24. Yang P, Zang Q, Kang J, Li H, He X. Comparison of clinical efficacy and safety among three surgical approaches for the treatment of spinal tuberculosis: a meta-analysis. Eur Spine J. 2016; 25 (12): 3862-74.
25. Cui X, Li LT, Ma YZ. Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous Thoracic Spinal Tuberculosis. Orthop Surg. 2016; 8 (4): 454-61.
26. Shi J, Tang X, Xu Y, et al. Single-stage internal fixation for thoracolumbar spinal tuberculosis using 4 different surgical approaches. J Spinal Disord Tech. 2014; 27 (7): E247-57.
27. Zhao J, Lian XF, Hou TS, Ma H, Chen ZM. Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. International orthopaedics, 2007; 31 (6): 859-63.
28. Klockner C, Valencia R. Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine (Phila Pa 1976). 2003; 28 (10): 1036-42.
Copyright (c) 2020 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.