Efficacy of Posterior and Posterolateral Approach for Decompression and Fusion for Thoracolumbar Tuberculosis
Keywords:TB (tuberculosis) spine
Objective: To study the efficacy of the posterior and posterolateral approach in thoracolumbar tuberculosis.
Material and Methods: 60 patients with thoracolumbar TB spine were enrolled in the study from 2015 to 2021. These patients had single-level disease with low back pain and neurological compromise in lower limbs. The diagnosis was made on an MRI of the spine and elevated ESR levels. All patients were started with antituberculous treatment. The pain was measured on the VAS score, and neurological status was assessed on the ASIA score. Kyphosis angle was calculated on a lateral x-ray of the spine. All patients were operated on by posterior and posterolateral approaches with decompression and fusion. At follow-up, fusion was assessed on every visit by x-ray along with neurological status and pain score.
Results: The mean age of patients was 45.8 years (25 to 66 years). 59.5% patients achieved radiological fusion on follow-up x-rays. There was a significant improvement in VAS score preoperatively mean and SD6.38 ± 1.24to postoperatively 4.45 ± 1.09. The mean and SD of kyphosis in patients preoperatively was 22.3 ± 3.06 to post-operative 22.3 ± 3.06 with a p-value < 0.05 which shows significant improvement.
Conclusion: Posterior and posterolateral decompression and fusion of thoracolumbar tuberculosis is a good surgical approach in respect of neurological outcome, correction of kyphosis, and pain improvement.
Anil Kumar Jain, S Rajasekaran, Karan Raj Jaggi, Vithal Prasad Myneedu. Tuberculosis of the Spine. J Bone Joint Surg Am. 2020; 102 (7): 617-628.
Khanna K, Sabharwal S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J. 2019; (11): 1858-1870.
Dunn RN, Ben Husien M. Spinal tuberculosis: review of current management. Bone Joint J. 2018; 100-B (4): 425-431.
Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med. 2011; 34 (5): 440-54.
Huelskamp L, Anderson S, Bernhardt M. TB of the spine: Pott's disease. Orthop Nurs. 2000; 19 (4): 31-5.
Hasan Khan MN, Jamal AB, Hafeez A, Sadiq M, Rasool MU. Is spinal tuberculosis changing with changing time? Ann Med Surg (Lond). 2021; 66: 102421.
Liu P, Zhu Q, Jiang J. Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976). 2011; 36 (20): E1290-5.
Merino P, Candel FJ, Gestoso I, Baos E, Picazo J. Microbiological diagnosis of spinal tuberculosis. Int Orthop. 2012; 36 (2): 233-8.
Patankar AP. Tuberculosis of spine: An experience of 30 cases over two years. Asian J Neurosurg. 2016 Jul; 11 (3): 226-31.
Alam MS, Phan K, Karim R, Jonayed SA, Munir HK, Chakraborty S, Alam T. Surgery for spinal tuberculosis: a multi-center experience of 582 cases. J Spine Surg. 2015; (1): 65-71.
Srivastava S, Marathe N, Bhosale S, Raj A, Dhole K, Agarwal H. Functional Outcome of Right-sided Thoracotomy for Tuberculosis of the Dorsal Spine. Asian J Neurosurg. 2020; 15 (2): 311-314.
Richardson JD, Campbell DL, Grover FL, Arom KV, Wilkins K, Wissinger JP, Trinkle JK. Transthoracic approach for Pott's disease. Ann Thorac Surg. 1976; 21 (6): 552-6.
Wang B, Lv G, Liu W, Cheng I. Anterior radical debridement and reconstruction using titanium mesh cage for the surgical treatment of thoracic and thoracolumbar spinal tuberculosis: minimum five-year follow-up. Turk Neurosurg. 2011; 21 (4): 575-81.
Omari B, Robertson JM, Nelson RJ, Chiu LC. Pott's disease. A resurgent challenge to the thoracic surgeon. Chest, 1989; 95 (1): 145-50.
Huang Z, Liu J, Ma K. Posterior versus Anterior Approach Surgery for Thoracolumbar Spinal Tuberculosis. J Coll Physicians Surg Pak. 2019; 29 (2): 187-188.
Ukunda UNF, Lukhele MM. The posterior-only surgical approach in the treatment of tuberculosis of the spine: outcomes using cortical bone allografts. Bone Joint J. 2018; 100-B (9): 1208-1213.
Shen J, Zheng Q, Wang Y, Ying X. One-stage combined anterior-posterior surgery for thoracic and lumbar spinal tuberculosis. J Spinal Cord Med. 2021; 44 (1): 54-61.
Zhong Y, Yang K, Ye Y, Huang W, Liu W, Luo J. Single Posterior Approach versus Combined Anterior and Posterior Approach in the Treatment of Spinal Tuberculosis: A Meta-Analysis. World Neurosurg. 2021; 147: 115-124.
Yadav G, Kandwal P, Arora SS. Short-term outcome of lamina-sparing decompression in thoracolumbar spinal tuberculosis. J Neurosurg Spine, 2020; 20: 1-8.
Li W, Liu Z, Xiao X, Xu Z, Sun Z, Zhang Z, Wang X. Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia. BMC Musculoskelet Disord. 2021; 22 (1): 213.
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