Surgical Outcome of Anterior Decompression, Grafting and Fixation in Dorsolumbar Caries Spine
Keywords:
Caries spine, anterior spinal decompression, ASIA Impairment Scale, Bridwell grading,, motor deficitAbstract
To evaluate the surgical outcome of anterior decompression, grafting and fixation in tuberculosis of the dorsal and lumbar spine.
Study Design: Retrospective study.
Place and Duration of Study: Department of Neurosurgery Unit – I, Lahore General Hospital, Lahore, From Jan 2008 to March 2012.
Materials and Methods: Patients with caries spine having compression over the thecal sac with neurological deficit and kyphosis were included in the study. Patients below 17 years and above 56 year of age; patients with bed sores and unfit patients for anesthesia were excluded from the study. Complete blood picture with ESR, X-ray Chest, X-ray of the relevant spinal level and MRI were done. All patients were treated with corpectomy, debri-dement, drainage of abscess and grafting followed by fixation with poly-axial screws and rods. All patients were assessed by ASIA Impairment Scale before and after surgery and with Bridwell grading after surgery.
Results: Among 79 patients, 47(59.49%) Male and 32(40.51%) Female patients, mean age was 37.2 ± 3 years. The commonest involved level was the dorsolumbar junction 53.16% (N = 42). Backache, sensory motor deficit and deformity were main presenting complains. Anterior decompression and grafting followed by fixation with poly axial screw and rods were done in all patients who fulfill the inclusion criteria. Lower limb power improved to ambulatory level in 60% of patients with complete paraplegia and recovery was excellent in patients with partial weakness; only n = 2 patients (2.53%) deteriorated to a lower grade. There was no postoperative mor-tality and one patient had long ICU stay due to lung injury. All patients have pain at the intercostal area and graft donor site that were treated with analgesia.
Conclusion: According to our study, corpectomy followed by grafting and fixation is safe and effective pro-cedure. Even those patients presenting with complete paraplegia showed improvement in motor power to ambu-latory level and those who had partial deficit showed excellent improvement.
References
2. Pott P. The chirurgical works of Percivall Pott, F.R.S., surgeon to St. Bartholomew’s Hospital, a new edition, with his last corrections. 1808. Clin Orthop Relat Res. May 2002; 4-10.
3. Davidson PT, Le HQ. Tuberculosis and Nontuberculous Mycobacterial Infections. In: Schlossberg D, ed. Mus-culoskeletal Tuberculosis. 4th ed. Saint Louis, MO: W B Saunders; 1999: 204-20.4. Leibert E, Haralambou G. Tuberculosis. In: Rom WN and Garay S, eds. Spinal tuberculosis. Lippincott, Willi-ams and Wilkins; 2004: 565-77.
5. Te Beek LA, van der Werf MJ, Richter C, et al. Extra-pulmonary tuberculosis by nationality, The Nether-lands, 1993 – 2001. Emerg Infect Dis. Sep 2006; 12 (9): 1375-82.
6. Benzagmout M, Boujraf S, Chakour K, Chaoui Mel F. Pott’s disease in children. Surg Neurol Int. Jan 11 2011; 2: 1.
7. Moon MS, Kim SS, Lee BJ, Moon JL. Spinal tubercu-losis in children: Retrospective analysis of 124 patients. Indian J Orthop. Mar 2012; 46 (2): 150-8.
8. Pola E, Rossi B, Nasto LA, Colangelo D, Logroscino CA. Surgical treatment of tuberculous spondylodiscitis. Eur Rev Med Pharmacol Sci. Apr 2012; 16 Suppl 2:79-85.
9. Cheung WY, Luk KD. Clinical and radiological out-comes after conservative treatment of TB spondylitis: is the 15 years’ follow-up in the MRC study long enough? Eur Spine J. May 8, 2012.
10. Lifeso RM, Weaver P, Harder EH. Tuberculous spon-dylitis in adults. J Bone Joint Surg Am. Dec 1985; 67 (9): 1405-13.
11. Pertuiset E, Beaudreuil J, Liote F, et al. Spinal tubercu-losis in adults. A study of 103 cases in a developed cou-ntry, 1980 – 1994. Medicine (Baltimore). Sep 1999; 78 (5): 309-20.
12. Turgut M. Spinal tuberculosis (Pott's disease): its clini-cal presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev. Mar 2001; 24 (1): 8-13.
13. Le Page L, Feydy A, Rillardon L, et al. Spinal tubercu-losis: a longitudinal study with clinical, laboratory, and imaging outcomes. Semin Arthritis Rheum. Oct 2006; 36 (2): 124-9.
14. Park DW, Sohn JW, Kim EH, et al. Outcome and man-agement of spinal tuberculosis according to the severity of disease: a retrospective study of 137 adult patients at Korean teaching hospitals. Spine. Feb 15 2007; 32 (4): E130-5.
15. Ferrer MF, Torres LG, Ramírez OA, Zarzuelo MR, Del Prado González N. Tuberculosis of the spine. A syste-matic review of case series. Int Orthop. Nov 25 2011.
16. Cormican L, Hammal R, Messenger J, et al. Current difficulties in the diagnosis and management of spinal tuberculosis. Postgrad Med J. Jan 2006; 82 (963): 46-51.
17. Jellis JE. Human immunodeficiency virus and osteoarti-cular tuberculosis. Clin Orthop Relat Res. May 2002; 27-31.
18. Moorthy S, Prabhu NK. Spectrum of MR imaging find-ings in spinal tuberculosis. AJR Am J Roentgenol. Oct 2002; 179 (4): 979-83.
19. Almeida A. Tuberculosis of the spine and spinal cord. Eur J Radiol. Aug 2005; 55 (2): 193-201.
20. Jung NY, Jee WH, Ha KY, et al. Discrimination of tuberculous spondylitis from pyogenic spondylitis on MRI. AJR Am J Roentgenol. Jun 2004; 182 (6): 1405-10.
21. Rajasekaran S, Prasad Shetty A, Dheenadhayalan J, et al. Morphological changes during growth in healed childhood spinal tuberculosis: a 15 – year prospective study of 61 children treated with ambulatory chemothe-rapy. J Pediatr Orthop. Nov – Dec 2006; 26 (6): 716-24.
22. Li L, Zhang Z, Luo F, Xu J, Cheng P, Wu Z, et al. Management of drug – resistant spinal tuberculosis with a combination of surgery and individualised chemothe-rapy: a retrospective analysis of thirty – five patients. Int Orthop. Nov 9 2011.
23. Jain AK. Tuberculosis of the spine. Clin Orthop Relat Res. Jul 2007; 460: 2-3.
24. Watts HG, Lifeso RM. Tuberculosis of bones and joi-nts. J Bone Joint Surg Am. Feb 1996; 78 (2): 288-98.
25. Ghadouane M, Elmansari O, Bousalmame N, et al; Role of surgery in the treatment of Pott's disease in adu-lts. Apropos of 29 cases. Rev Chir Orthop Reparatrice Appar Mot. 1996; 82 (7): 620-8.
26. Cabrera Orduna A; Surgical management of Pott’s paraplegia. Bol Med Hosp Infant Mex. 1980 Nov – Dec; 37 (6): 1141-53.
27. Kapoor S, Kapoor S, Agrawal M, Aggarwal P, Jain BK Jr. Thoracoscopic decompression in Pott's spine and its long – term follow-up. Int Orthop. Feb 2012; 36 (2): 331-7.
28. Ditunno JF, Young W, Donovan WH, Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 1994; 32 (2): 70-80.
29. Maynard FM, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord 1997; 35 (5): 266-74.
30. Bridwell KH, Lenke LG, McEnery KW, Baldus C, Bla-nke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult pati-ents with kyphosis or anterior column defects? Spine (Phila Pa 1976) 1995; 20: 1410–8.
31. Kumar R. Spinal tuberculosis: with reference to the chi-ldren of northern India.Childs Nerv Syst 2005 Jan; 21 (1): 19-26.
32. Tuli SM. Current concepts: Severe kyphotic deformity in tuberculosis of the spine. Int orthop (SICOT) 1995; 19: 327-331.
33. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 2010; 92 (7): 905-13.
34. Lee JS, Moon KP, Kim SJ, Suh KT. Posterior lumbar inter-body fusion and posterior instrumentation in the surgical management of lumbar tuberculous spondylitis.J Bone Joint Surg Br 2007; 89 (2): 210-4. 35. Yilmaz C, Selek HY, Gürkan I,Erdemli B, Korkusuz Z. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 1999; 81 (9): 1261-7.
36. Benli IT, Acaro?lu E, Akalin S, Ki? M, Duman E, Un A. Anterior radical debridement and anterior instrumen-tation in tuberculosis spondylitis. Eur Spine J 2003; 12 (2): 224-34.
37. Jin D, Qu D, Chen J, Zhang H. One – stage anterior inter-body auto-grafting and instrumentation in primary surgical management of thoracolumbar spinal tubercu-losis. Eur Spine J 2004; 13 (2): 114-21.
38. Tuli SM. Results of treatment of spinal tuberculosis by ‘middle pat
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).
