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A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study

  • Orthopaedic Surgery
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Abstract

Introduction

Osteotomized debridement (OD) is increasingly used in the treatment of active thoracolumbar tuberculosis (TB). So far, no nomenclature has been established to describe the patterns of OD, and thus the surgical outcomes cannot be directly analyzed and compared among the patients treated with different extents of OD. The purpose of this study was to establish a reliable classification of OD for further study of spinal TB.

Materials and Methods

This was a multicenter retrospective study. The proposed classification included 6 grades of OD based on sagittal range of vertebral body destruction: grade 0 involves single-level intervertebral disc and adjacent superficial endplates; grade 1 involves adjacent endplates and vertebral bodies, but no pedicle is involved; grade 2 involves adjacent endplates, vertebral bodies, and a lower or upper pedicle; grade 3 involves adjacent endplates, vertebral bodies, and both of lower and upper pedicles; grade 4 involves an entire vertebral body and an adjacent lower or upper pedicle; grade 5 involves two continuous entire vertebral bodies. Two hundred and five patients with active thoracolumbar TB who underwent OD surgery were included, and all ODs were classified. The reliability of this classification was evaluated twice by 10 readers, and Fleiss kappa coefficients were calculated.

Results

In the 205 patients, 208 ODs were performed. Grade 2 OD was the commonest type (98/208, 47.1%), followed by grade 1 (50/208, 24.0%), grade 3 (26/208, 12.5%), grade 0 (20/208, 9.6%), grade 4 (8/208, 3.8%), and grade 5 (6/208, 2.9%). The average accuracy of the two readings was 86.2% and 90.1%, respectively. The intra-rater reliability for the classification was “almost perfect agreement” with a Fleiss kappa coefficient average of 0.92. The inter-rater reliability was “almost perfect agreement” with a coefficient average of 0.89 for two readings.

Conclusions

This classification proved to be intuitive and reliable. The graded OD provides a platform for preoperative evaluation and allows comparative analysis of clinical outcomes in different extents of OD.

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Data availability

All data gathered can be requested from the corresponding author.

References

  1. Dunn RN, Ben HM (2018) Spinal tuberculosis. The Bone and Joint Journal 100:425–431

    PubMed  Google Scholar 

  2. Klöckner 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 28:1036–1042

    Article  PubMed  Google Scholar 

  3. Rajasekaran S (2012) Kyphotic deformity in spinal tuberculosis and its management. Int Orthop 36:359–365. https://doi.org/10.1007/s00264-011-1469-2

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang YX, Zhang HQ, Li M, Tang MX, Guo CF, Deng A, Gao Q, Wu JH, Liu JY (2017) Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only. Injury 48:378–383. https://doi.org/10.1016/j.injury.2016.12.025

    Article  PubMed  Google Scholar 

  5. Wang X, Pang X, Wu P, Luo C, Shen X (2014) 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. Eur Spine J 23:830–837. https://doi.org/10.1007/s00586-013-3051-7

    Article  PubMed  Google Scholar 

  6. Pang X, Wu P, Shen X, Li D, Luo C, Wang X (2013) One-stage posterior transforaminal lumbar debridement, 360 degrees interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis. Arch Orthop Trauma Surg 133:1033–1039. https://doi.org/10.1007/s00402-013-1751-4

    Article  PubMed  Google Scholar 

  7. Turgut M (2001) Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients. Neurosurg Rev 24:8–13. https://doi.org/10.1007/pl00011973

    Article  CAS  PubMed  Google Scholar 

  8. Ma S, Zhou Z, Wan Z, Duan P, Huang S, Xu J, Deng W, Wu C, Cao K (2022) Osteotomized debridement versus curetted debridement in posterior approach in treating thoracolumbar tuberculosis: a comparative study. Eur Spine J 31:473–481. https://doi.org/10.1007/s00586-021-07075-w

    Article  PubMed  Google Scholar 

  9. 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 46:165–170. https://doi.org/10.4103/0019-5413.93682

    Article  PubMed  PubMed Central  Google Scholar 

  10. Zhang HQ, Li JS, Zhao SS, Shao YX, Liu SH, Gao Q, Lin MZ, Liu JY, Wu JH, Chen J (2012) Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches. Arch Orthop Trauma Surg 132:1717–1723. https://doi.org/10.1007/s00402-012-1618-0

    Article  PubMed  Google Scholar 

  11. Demirel M, Akgul T, Pehlivanoglu T, Karademir G, Bayram S, Dikici F, Sar C (2019) Posterior approach alone versus combined anterior and posterior approach in the management of vertebral tuberculosis. Turk Neurosurg 29:724–733. https://doi.org/10.5137/1019-5149.JTN.25968-19.3

    Article  PubMed  Google Scholar 

  12. Zhou Y, Li W, Liu J, Gong L, Luo J (2018) Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis. BMC Surg 18:71. https://doi.org/10.1186/s12893-018-0405-4

    Article  PubMed  PubMed Central  Google Scholar 

  13. Li L, Xu J, Ma Y, Tang D, Chen Y, Luo F, Li D, Hou T, Zhou Q, Dai F, He Q, Zhang Z, (2014) Surgical strategy and management outcomes for adjacent multisegmental spinal tuberculosis: a retrospective study of forty-eight patients. Spine (Phila Pa 1976) 39:E40-48. https://doi.org/10.1097/BRS.0000000000000053

  14. Feng Y, Wang YS, Lv J, Lv Z, Zhao B, Zhao S, Cheng CT (2020) Treatment of spinal tuberculosis of GATA Type III: primary posterior debridement combined with osteotomy parallel to the endplates for reconstruction. Orthop Surg 12:997–1004. https://doi.org/10.1111/os.12650

    Article  PubMed  PubMed Central  Google Scholar 

  15. Ma S, Zhou Z, Yu H, Zhong J, Xiong J, Xu J, Deng W, Cao K (2022) Posterior approach with osteotomized debridement versus combined anterior and posterior approach in treating thoracolumbar tuberculosis: a retrospective cohort study. Global Spine J. https://doi.org/10.1177/21925682221123321

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ma S, Zhou Z, Yu H, Zhong J, Xiong J, Xu J, Deng W, Cao K (2022) Global spinal realignment after osteotomized debridement in active lumbar spinal tuberculosis: correlation with patient-reported outcomes. World Neurosurg 164:e1153–e1160. https://doi.org/10.1016/j.wneu.2022.05.120

    Article  PubMed  Google Scholar 

  17. Lee C, Vessa P, Lee J (1995) Chronic disabling low back pain syndrome caused by internal disc derangements. the results of disc excision and posterior lumbar interbody fusion. Spine 20:356–361. https://doi.org/10.1097/00007632-199502000-00018

    Article  CAS  PubMed  Google Scholar 

  18. Landis J, Koch G (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174. https://doi.org/10.2307/2529310

    Article  CAS  PubMed  Google Scholar 

  19. Ames CP, Smith JS, Scheer JK, Shaffrey CI, Lafage V, Deviren V, Moal B, Protopsaltis T, Mummaneni PV, Mundis GM Jr, Hostin R, Klineberg E, Burton DC, Hart R, Bess S, Schwab FJ, International Spine Study G (2013) A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine. https://doi.org/10.3171/2013.5.SPINE121067

    Article  PubMed  Google Scholar 

  20. Schwab F, Blondel B, Chay E, Demakakos J, Lenke L, Tropiano P, Ames C, Smith JS, Shaffrey CI, Glassman S, Farcy JP, Lafage V (2014) The comprehensive anatomical spinal osteotomy classification. Neurosurgery 74:112–120. https://doi.org/10.1227/NEU.0000000000000182o

    Article  PubMed  Google Scholar 

  21. Jin W, Wang Q, Wang Z, Geng G (2014) Complete debridement for treatment of thoracolumbar spinal tuberculosis: a clinical curative effect observation. Spine J 14:964–970. https://doi.org/10.1016/j.spinee.2013.07.466

    Article  PubMed  Google Scholar 

  22. Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M (2013) Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. Eur Spine J 22(Suppl 4):618–623. https://doi.org/10.1007/s00586-012-2459-9

    Article  PubMed  Google Scholar 

  23. Swanson AN, Pappou IP, Cammisa FP, Girardi FP (2006) Chronic infections of the spine: surgical indications and treatments. Clin Orthop Relat Res 444:100–106. https://doi.org/10.1097/01.blo.0000203447.44146.55

    Article  PubMed  Google Scholar 

  24. Wang LJ, Zhang HQ, Tang MX, Gao QL, Zhou ZH, Yin XH (2017) Comparison of three surgical approaches for thoracic spinal tuberculosis in adult: minimum 5-year follow up. Spine (Phila Pa 1976 https://doi.org/10.1097/BRS.0000000000001955

  25. Wu P, Wang XY, Li XG, Shen XJ, Pang XY, Luo CK, Xu ZQ, Zeng H, Zhang PH, Peng W (2015) One-stage posterior procedure in treating active thoracic spinal tuberculosis: a retrospective study. Eur J Trauma Emerg Surg 41:189–197. https://doi.org/10.1007/s00068-014-0421-8

    Article  CAS  PubMed  Google Scholar 

  26. Hodgson A, Stock F, Fang H, Ong G (1960) Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott’s disease of the spine. British J Surg 48:172–178. https://doi.org/10.1002/bjs.18004820819

    Article  CAS  Google Scholar 

  27. Benli IT, Acaroglu E, Akalin S, Kis M, Duman E, Un A (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12:224–234. https://doi.org/10.1007/s00586-002-0403-0

    Article  PubMed  Google Scholar 

  28. Ma YZ, Cui X, Li HW, Chen X, Cai XJ, Bai YB (2012) Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 36:299–305. https://doi.org/10.1007/s00264-011-1390-8

    Article  PubMed  Google Scholar 

  29. Pu X, Zhou Q, He Q, Dai F, Xu J, Zhang Z, Branko K (2012) A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. Int Orthop 36:307–313. https://doi.org/10.1007/s00264-011-1329-0

    Article  PubMed  Google Scholar 

  30. Cui X, Li LT, Ma YZ (2016) Anterior and posterior instrumentation with different debridement and grafting procedures for multi-level contiguous thoracic spinal tuberculosis. Orthop Surg 8:454–461. https://doi.org/10.1111/os.12288

    Article  PubMed  PubMed Central  Google Scholar 

  31. Kim BJ, Ko HS, Lim Y, Seo JG, Jeon TH (1993) The clinical study of the tuberculous spondylitis. J Korean Orthopaedic Association 28:2221

    Article  Google Scholar 

  32. Zeng H, Shen X, Luo C, Xu Z, Zhang Y, Liu Z, Wang X (2015) Comparison of three surgical approaches for cervicothoracic spinal tuberculosis: a retrospective case-control study. J Orthop Surg Res 10:100. https://doi.org/10.1186/s13018-015-0238-0

    Article  PubMed  PubMed Central  Google Scholar 

  33. Liu J, Wan L, Long X, Huang S, Dai M, Liu Z (2015) Efficacy and safety of posterior versus combined posterior and anterior approach for the treatment of spinal tuberculosis: a meta-analysis. World Neurosurg 83:1157–1165. https://doi.org/10.1016/j.wneu.2015.01.041

    Article  PubMed  Google Scholar 

Download references

Funding

This work was funded by National Natural Science Foundation of China (No.81860473, 81460405), Key project of Natural Science Foundation of Jiangxi Provincial (No. 20202ACB206004), Major Discipline Academic and Technical Leaders Training Program of Jiangxi Province (No. 20204BCJ22026) and the Program of Health Commission of Jiangxi Province (No.20191029).

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KC and SM contributed to the study conception and design. Material preparation, data collection and analysis were performed by ZZ, ZG, WW, YW and RZ. The first draft of the manuscript was written by SM and ZZ and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Kai Cao.

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The data does not compromise anonymity or confidentiality or breach local data protection laws, and it is approved for publication by The First Affiliated Hospital of Nanchang University, General Hospital of Ningxia Medical University, The Second Affiliated Hospital of Kunming Medical University, and The Second Affiliated Hospital of Nanchang University.

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Ma, S., Zhou, Z., Ge, Z. et al. A novel classification of osteotomized debridement based on the range of focus in treating active thoracolumbar tuberculosis: a multicenter study. Arch Orthop Trauma Surg 143, 5565–5574 (2023). https://doi.org/10.1007/s00402-023-04869-z

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