European Spine Journal

, Volume 23, Issue 4, pp 830–837 | Cite as

One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis

  • Xiyang Wang
  • Xiaoyang Pang
  • Ping Wu
  • Chengke Luo
  • Xiongjie Shen
Original Article

Abstract

Purpose

The aim of this study was to compare single posterior debridement, interbody fusion and instrumentation with one-stage anterior debridement, interbody fusion and posterior instrumentation for treating thoracic and lumbar spinal tuberculosis.

Method

From January 2006 to January 2010, we enrolled 115 spinal tuberculosis patients with obvious surgical indications. Overall, 55 patients had vertebral body destruction, accompanied by a flow injection abscess or a unilateral abscess volume greater than 500 ml. The patients underwent one-staged anterior debridement, bone grafting and posterior instrumentation (group A) or single posterior debridement, bone grafting and instrumentation (group B). Clinical and radiographic results for the two groups were analyzed and compared.

Results

Patients were followed 12–36 months (mean 21.3 months), Fusion occurred at 4–12 months (mean 7.8 months). There were significant differences between groups regarding the post-operative kyphosis angle, angle correction and angle correction rate, especially if pathology is present in thoracolumbar and lumbar regions. Operative complications affected five patients in group A, and one patient in group B. A unilateral psoas abscess was observed in three patients 12 months postoperatively. In one of them, interbody fusion did not occur, and there was fixation loosening and interbody absorption. All of them were cured by an anterior operation.

Conclusion

Anterior debridement and bone grafting with posterior instrumentation may not be the best choice for treating patients with spinal tuberculosis. Single posterior debridement/bone grafting/instrumentation for single-segment of thoracic or lumbar spine tuberculosis produced good clinical results, except in patients who had a psoas abscess.

Keywords

Spinal tuberculosis Bone grafting Anterior debridement Posterior debridement Instrumentation 

Notes

Acknowledgments

This publication was funded in part by the National Natural Science Foundation of China (81171736).

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Lee TC, Lu K, Yang LC, Huang HY, Liang CL (1999) Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 91(2 Suppl):163–169PubMedGoogle Scholar
  2. 2.
    World Health Organization (2004) Global tuberculosis control. WHO Report, Switzerland, p 22Google Scholar
  3. 3.
    Slucky AV, Eismont FJ (1997) Spinal infections. In: Bridwell KH, Dewald RL (eds) The textbook of spinal surgery. Lippincott Raven, Philadelphia, pp 2141–2183Google Scholar
  4. 4.
    Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24(1):8–13PubMedCrossRefGoogle Scholar
  5. 5.
    Korovessis P, Petsinis G, Koureas G, Iliopoulos P, Zacharatos S (2006) Anterior surgery with insertion of titanium mesh cage and posterior instrumented fusion performed sequentially on the same day under one anesthesia for septic spondylitis of thoracolumbar spine: is the use of titanium mesh cages safe? Spine 31(9):1014–1019. doi:10.1097/01.brs.0000215049.08622.9d PubMedCrossRefGoogle Scholar
  6. 6.
    Shipley JA, Craig JB (1993) Spinal tuberculosis with translational instability. Spine 18(3):397–401PubMedCrossRefGoogle Scholar
  7. 7.
    Benli IT, Kaya A, Acaroglu E (2007) Anterior instrumentation in tuberculous spondylitis: is it effective and safe? Clin Orthop Relat Res 460:108–116. doi:10.1097/BLO.0b013e318065b70d PubMedGoogle Scholar
  8. 8.
    Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 90(11):1477–1481. doi:10.1302/0301-620X.90B11.20972 PubMedCrossRefGoogle Scholar
  9. 9.
    Hodgson AR, Stock FE, Fang HS, Ong GB (1960) Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. Br J Surg 48:172–178PubMedCrossRefGoogle Scholar
  10. 10.
    Hee HT, Majd ME, Holt RT, Pienkowski D (2002) Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 15(2):149–156 (discussion 156)PubMedCrossRefGoogle Scholar
  11. 11.
    Fukuta S, Miyamoto K, Masuda T, Hosoe H, Kodama H, Nishimoto H, Sakaeda H, Shimizu K (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28(15):E302–E308. doi:10.1097/01.BRS.0000083318.40123.5E PubMedGoogle Scholar
  12. 12.
    Laheri VJ, Badhe NP, Dewnany GT (2001) Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 39(8):429–436. doi:10.1038/sj.sc.3101185 PubMedCrossRefGoogle Scholar
  13. 13.
    Rowe SM, Chung JY, Moon ES, Song EK (1991) Bent plate fixation in combined intertrochanteric and subtrochanteric fractures of the femur. Orthopedics 14(10):1123–1128PubMedGoogle Scholar
  14. 14.
    Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20(17):1910–1916PubMedCrossRefGoogle Scholar
  15. 15.
    Louw JA (1990) Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion. J Bone Joint Surg Br 72(4):686–693PubMedGoogle Scholar
  16. 16.
    Jain AK, Aggarwal A, Dhammi IK, Aggarwal PK, Singh S (2004) Extrapleural anterolateral decompression in tuberculosis of the dorsal spine. J Bone Joint Surg Br 86(7):1027–1031PubMedCrossRefGoogle Scholar
  17. 17.
    Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92(7):905–913. doi:10.1302/0301-620X.92B7.24668 PubMedCrossRefGoogle Scholar
  18. 18.
    Lee CK, Vessa P, Lee JK (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine 20(3):356–361PubMedCrossRefGoogle Scholar
  19. 19.
    Kim BJ, Ko HS, Lim Y et al (1993) The clinical study of tuberculous spondylitis. J Korean Orthop Assoc 28:2221–2232Google Scholar
  20. 20.
    Schulitz KP, Kothe R, Leong JC, Wehling P (1997) Growth changes of solidly fused kyphotic bloc after surgery for tuberculosis. Comparison of four procedures. Spine 22(10):1150–1155PubMedCrossRefGoogle Scholar
  21. 21.
    Dai LY, Jiang LS, Wang W, Cui YM (2005) Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis. Spine 30(20):2342–2349PubMedCrossRefGoogle Scholar
  22. 22.
    Deng Y, Lv G, An HS (2009) En bloc spondylectomy for the treatment of spinal tuberculosis with fixed and sharply angulated kyphotic deformity. Spine 34(20):2140–2146. doi:10.1097/BRS.0b013e3181b34ce7 PubMedCrossRefGoogle Scholar
  23. 23.
    Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V (2003) Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br 85(1):100–106PubMedCrossRefGoogle Scholar
  24. 24.
    Klockner C, Valencia R (2003) Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis. Spine 28(10):1036–1042. doi:10.1097/01.BRS.0000061991.11489.7F PubMedGoogle Scholar
  25. 25.
    Zhang HQ, Guo CF, Xiao XG, Long WR, Deng ZS, Chen J (2007) One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion. J Spinal Disord Tech 20(4):263–267. doi:10.1097/01.bsd.0000211281.68400.1b PubMedCrossRefGoogle Scholar
  26. 26.
    Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33(5):1385–1390. doi:10.1007/s00264-009-0758-5 PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Gokce A, Ozturkmen Y, Mutlu S, Caniklioglu M (2008) Spinal osteotomy: correcting sagittal balance in tuberculous spondylitis. J Spinal Disord Tech 21(7):484–488. doi:10.1097/BSD.0b013e3181586023 PubMedCrossRefGoogle Scholar
  28. 28.
    Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A (2012) Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: a retrospective analysis. Indian J Orthop 46(2):165–170. doi:10.4103/0019-5413.93682 PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Pang X, Shen X, Wu P, Luo C, Xu Z, Wang X (2013) Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. Arch Orthop Trauma Surg. doi:10.1007/s00402-013-1722-9 Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Xiyang Wang
    • 1
  • Xiaoyang Pang
    • 1
  • Ping Wu
    • 1
  • Chengke Luo
    • 1
  • Xiongjie Shen
    • 1
  1. 1.Department of Spine SurgeryThe Xiangya Hospital of Central South UniversityChangshaPeople’s Republic of China

Personalised recommendations