Skip to main content

Advertisement

SpringerLink
Log in

One-stage posterior procedure in treating active thoracic spinal tuberculosis: a retrospective study

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

To investigate the clinical efficacy and feasibility of surgical treatment for thoracic spinal tuberculosis with neurological deficit by one-stage posterior instrumentation, proper transpedicular debridement, without anterior instrumentation and without anterior or posterior bone graft.

Methods

A total of 19 cases with thoracic tuberculosis, neurological deficit and bone destruction (without severe kyphosis) admitted to the hospital from May 2005 to January 2010 were treated by internal fixation, transpedicular debridement without bone graft via the isolated posterior approach. Operating time, blood loss, complications, neurological function, deformity correction, pain relief, and inter-body fusion were investigated.

Results

The average mean operating time was 168.9 ± 21.1 min. The average blood loss during operation was 655.8 ± 82.8 ml. All patients were followed for 28–46 months post-operation (average, 36.8 ± 5.8 months). All patients had significant postoperative improvement in ASIA classification scores and VAS scores. The thoracic kyphotic angle was significantly decreased to 11.6°–20.2° after operation (average, 15.6° ± 2.2°), and the angle was 12.3°–21.6° (average, 16.4° ± 2.2°) at final follow-up. No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate and C-reactive protein recovered to normal within 3 months after operation in all patients. All patients have got spontaneous bony fusion within 6–9 months after surgery.

Conclusions

One-stage posterior instrumentation, transpedicular debridement without bone graft can be an effective and feasible treatment method for selected thoracic spinal tuberculosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jain AK. Tuberculosis of the spine: a fresh look at an old disease. J Bone Jt Surg Br. 2010;92(7):905–13.

    Article  CAS  Google Scholar 

  2. Pigrau-Serrallach C, Rodríguez-Pardo D. Bone and joint tuberculosis. Eur Spine J. 2013;22:556–66 (Suppl 4).

    Article  PubMed Central  PubMed  Google Scholar 

  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. Vol 80 (3): pp 456–462.

  4. Ma YZ, Cui X, Li HW, Chen X, Cai XJ, Bai YB. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop. 2012;36(2):299–305.

    Article  PubMed Central  PubMed  Google Scholar 

  5. Wang XB, Li J, Lü GH, Wang B, Lu C, Kang YJ. Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. Int Orthop. 2012;36(2):373–80.

    Article  PubMed Central  PubMed  Google Scholar 

  6. 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 J. 2011;11(8):726–33.

    Article  PubMed  Google Scholar 

  7. Lee SH, Sung JK, Park YM. Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech. 2006;19(8):595–602.

    Article  PubMed  Google Scholar 

  8. Lee CK, Vessa P, Lee JK. Chronic disabling low back pain syndrome caused by internal disc derangements. The results of disc excision and posterior lumbar interbody fusion. Spine. 1995;20(3):356–61.

    Article  CAS  PubMed  Google Scholar 

  9. Bailey HL, Gabriel SM, Hodgson AR, Shin JS. Tuberculosis of the spine in children: operative findings and results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Jt Surg Am. 1972;54:1633–57.

    CAS  Google Scholar 

  10. Medical Research Council Working Party on Tuberculosis of the Spine. A controlled trial of ambulatory treatment, debridement and anterior spinal fusion in the management of the tuberculosis of the spine: Studies in Vulawayo (Rhodesia) and in Hong Kong. J Bone Jt Surg Br. 1978;60:163–77.

    Google Scholar 

  11. Medical Research Council Working Party on Tuberculosis of the Spine. A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. J Bone Jt Surg Br. 1982;64:393–8.

    Google Scholar 

  12. Pettiford BL, Schuchert MJ, Jeyabalan G, et al. Technical challenges and utility of anterior exposure for thoracic spine pathology. Ann Thorac Surg. 2008;86(6):1762–8.

    Article  PubMed  Google Scholar 

  13. Chacko AG, Moorthy RK, Chandy MJ. The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study. Spine. 2004;29(17):E363–7.

    Article  PubMed  Google Scholar 

  14. Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res. 2002;398:50–9.

    Article  PubMed  Google Scholar 

  15. Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V. Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Jt Surg Br. 2003;85(1):100–6.

    Article  CAS  Google Scholar 

  16. Zhang HQ, Li JS, Zhao SS, et al. Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Archives Orthop Trauma Sur. 2012;132(12):1717–23.

    Article  Google Scholar 

  17. Nussbaum ES, Rockswold GL, Bergman TA, Erickson DL, Seljeskog EL. Spinal tuberculosis: a diagnostic and management challenge. J Neurosurg. 1995;83(2):243–7.

    Article  CAS  PubMed  Google Scholar 

  18. Rezai AR, Lee M, Cooper PR, Errico TJ, Koslow M. Modern management of spinal tuberculosis. Neurosurgery. 1995;36(1):87–97 (discussion 97–88).

    Article  CAS  PubMed  Google Scholar 

  19. Boachie-Adjei O, Squillante RG. Tuberculosis of the spine. Orthop Clinic North Am. 1996;27(1):95–103.

    CAS  Google Scholar 

  20. Desai SS. Early diagnosis of spinal tuberculosis by MRI. J Bone Jt Surg Br. 1994;76(6):863–9.

    CAS  Google Scholar 

  21. Kim NH, Lee HM, Suh JS. Magnetic resonance imaging for the diagnosis of tuberculous spondylitis. Spine. 1994;19(21):2451–5.

    Article  CAS  PubMed  Google Scholar 

  22. Medical Research Council Working Party on Tuberculosis of the Spine. Controlled trial of short-course regimens of chemotherapy in the ambulatory treatment of spinal tuberculosis. Results at three years of a study in Korea. J Bone Jt Surg. 1993;75:240–8 (Br).

    Google Scholar 

  23. Medical Research Council Working Party on Tuberculosis of the Spine. Five-years assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months’ duration for spinal tuberculosis in patients ambulatory from the start or undergoing radical surgery. Fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop. 1999;23:73–81.

    Article  Google Scholar 

  24. Guven O, Kumano K, Yalcin S, Karahan M, Tsuji S. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine. 1994;19(9):1039–43.

    Article  CAS  PubMed  Google Scholar 

  25. Kumar MN, Joseph B, Manur R. Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting. Eur Spine J. 2013;22(3):624–32.

    Article  Google Scholar 

  26. Lee TC, Lu K, Yang LC, Huang HY, Liang CL. Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg. 1999;91(2 Suppl):163–9.

    CAS  PubMed  Google Scholar 

  27. Kumar MN, Joseph B, Manur R. Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting. Eur Spine J. 2013;22(3):624–32.

    Article  Google Scholar 

  28. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine. 2003;28(15):E302–8.

    PubMed  Google Scholar 

  29. Broner FA, Garland DE, Zigler JE. Spinal infections in the immunocompromised host. Orthop Clinic North Am. 1996;27(1):37–46.

    CAS  Google Scholar 

  30. Altman GT, Altman DT, Frankovitch KF. Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop Relat Res. 1996;325:225–31.

    Article  PubMed  Google Scholar 

  31. Seiler JG 3rd, Johnson J. Iliac crest autogenous bone grafting: donor site complications. J South Orthop Assoc. 2000;9(2):91–7.

    PubMed  Google Scholar 

  32. Sasso RC, LeHuec JC, Shaffrey C. Iliac crest bone graft donor site pain after anterior lumbar interbody fusion: a prospective patient satisfaction outcome assessment. J Spinal Disord Tech. 2005;18(Suppl):S77–81.

    Article  PubMed  Google Scholar 

  33. Talu U, Gogus A, Ozturk C, Hamzaoglu A, Domanic U. The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. J Spinal Disord Tech. 2006;19(8):554–9.

    Article  PubMed  Google Scholar 

  34. Puig Guri J. The formation and significance of vertebral ankylosis in tuberculous spines. J Bone Jt Surg. 1947;29:136–48.

    CAS  Google Scholar 

  35. Moon MS, Moon YW, Moon JL, Kim SS, Sun DH. Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop Relat Res. 2002;398:40–9.

    Article  PubMed  Google Scholar 

  36. Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, Vaccaro AR. A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop. 2008;32(1):127–33.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

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

Conflict of interest

Ping Wu, Xi-yang Wang, Xiao-gang Li, Xiong-jie Shen, Xiao-yang Pang, Cheng-ke Luo, Zheng-quan Xu, Hao Zeng, Peng-hui Zhang, Wei Peng declare that they have no conflict of interest with the article.

Ethical standard

Our study has been approved by the Ethics Committee of the Xiangya Hospital and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Written informed consent was obtained from every patient prior to his/her inclusion in the study. Details that might disclose the identity of the subjects under study were omitted. All authors certify that we all comply with the Ethical guidelines for authorship and publishing in the European Journal of Trauma and Emergency Surgery.

Author information

Authors and Affiliations

  1. Department of emergency, Xiang-Ya Hospital, Central-South University, 87, Xiang-Ya Road, Changsha, 410008, People’s Republic of China

    P. Wu & X. G. Li

  2. Department of spine surgery, Xiang-Ya Hospital, Central-South University, 87, Xiang-Ya Road, Changsha, 410008, People’s Republic of China

    X. Y. Wang, X. Y. Pang, C. K. Luo, Z. Q. Xu, H. Zeng, P. H. Zhang & W. Peng

  3. Department of spine surgery, Hunan Provincial People’s Hospital, Hunan Normal University, 61, West jiefang Road, Changsha, 410005, People’s Republic of China

    X. J. Shen

Authors
  1. P. Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. X. Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. X. G. Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. X. J. Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. X. Y. Pang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. K. Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Z. Q. Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. H. Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. P. H. Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. W. Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to X. Y. Wang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wu, P., Wang, X.Y., Li, X.G. et al. One-stage posterior procedure in treating active thoracic spinal tuberculosis: a retrospective study. Eur J Trauma Emerg Surg 41, 189–197 (2015). https://doi.org/10.1007/s00068-014-0421-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00068-014-0421-8

Keywords

Search

Navigation