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One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis

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Abstract

There are few articles in the literature concerning anterior instrumentation in the surgical management of spinal tuberculosis in the exudative stage. So we report here 23 cases of active thoracolumbar spinal tuberculosis treated by one-stage anterior interbody autografting and instrumentation to verify the importance of early reconstruction of spinal stability and to evaluate the results of one-stage interbody autografting and anterior instrumentation in the surgical management of the exudative stage of throracolumbar spinal tuberculosis. Twenty-three patients, including two children (9 and 15 years old, respectively) and 21 adults with thoracolumbar spinal tuberculosis were treated surgically. T9 to L4 spinal segments were affected, and MRI/CT showed evident collapse of the vertebrae because of tuberculous destruction and paravertebral abscess. Neurological deficits were found in 15 patients. Before surgery, patients received standard anti-tuberculosis chemotherapy for 2 to 3 weeks. Under general endotracheal anaesthesia, the patients were placed in right recumbent positions, and a transthoracic, lateral extracavitary or extrapleural approach was chosen according to the tuberculosis lesion segment. After exposure, the tuberculous lesion region, including the collapsed vertebrae and in-between intervertebral disc, was almost completely resected in order to release the segmental spinal cord. Then, autologous iliac, rib or fibular graft was harvested to complete interbody fusion, and an anterior titanium-alloy plate-screw system was used to reconstruct the stability of the affected segments. Anti-tuberculosis chemotherapy was continued for at least 9 months, and the patients were supported with thoracolumbosacral orthosis for 6 months after surgery. All patients were followed up for an average of 2 years. All 23 cases were healed without chronic sinus formation or any recurrence of tuberculosis during the follow-up period. Spinal fusion occurred at a mean of 3.8 months after surgery. Of all patients with neurological deficits, 14 patients showed obvious improvement; only one patient with Frankel C lesion remained unchanged, but none of the patients got worse. During the follow-up period, a mean of 18 degrees of kyphosis correction was achieved after surgery in the adult group. Moderate progressive kyphosis because of this procedure fusion occurred postoperatively in a 9-year-old child after 2 1/2 years; another 15-year-old child did not demonstrate this phenomenon. Except for the early loosening of one screw in two cases (which did not affect the reconstruction of spinal stability), no other complications associated with this procedure were found during follow-up. Early reconstruction of spinal stability plays an important role in the surgical management of spinal tuberculosis. One-stage anterior interbody autografting and instrumentation in the surgical management of the exudative stage of spinal tuberculosis show more advantages in selected patients, but supplementary posterior fusion should be considered to prevent postoperative kyphosis when this procedure is performed in children.

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References

  1. Altman GT, Altman DT, Frankovitch KF (1996) Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop:225–231

    Google Scholar 

  2. Bailey HL, Gabriel M, Hodgson AR, et al (1972) Tuberculosis of the spine in children. Operative findings and results in 100 consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg Am 54A:1633–1657

    Google Scholar 

  3. Boachie-Adjei O, Squillante R G (1996) Tuberculosis of the spine. Orthop Clin North Am 27:95–103

    CAS  PubMed  Google Scholar 

  4. Faraj AA (2001) Anterior instrumentation for the treatment of spinal tuberculosis (letter).J Bone Joint Surg Am 83A:463

    Google Scholar 

  5. Fountain SS, Hsu LCS, Yau AC, et al (1975) Progressive kyphosis following solid anterior spine fusion in children with tuberculosis of the spine. J Bone Joint Surg Am 57A:1104–1107

    Google Scholar 

  6. Guven O. Kumano K, Yalcin S (1994) A single posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043

    CAS  PubMed  Google Scholar 

  7. Hodgson AR, Stock FE (1960) Anterior spine fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment in the first 100 cases. J Bone Joint Surg Am 42:295–310

    Google Scholar 

  8. Kemp HBS, Jackson JW, Jeremiah JD, et al (1973) Anterior fusion of the spine for infective lesions in adults. J Bone Joint Surg Br 55:715–734

    CAS  PubMed  Google Scholar 

  9. Lee TC, Lu K, Yang LC, et al (1999) Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 91:163–169

    CAS  Google Scholar 

  10. Mankin HJ (2001) Tuberculosis of bone and joints: the Red King lives. Curr Opin Orthop 12:489–498

    Article  Google Scholar 

  11. Medical Research Council Working Party on Tuberculosis of Spine (1973) A controlled trial of ambulant outpatient and inpatient rest in bed in the management of tuberculosis of the spine in young Korean patients on standard chemotherapy. J Bone Joint Surg Br 55:678–697

    PubMed  Google Scholar 

  12. Medical Research Council Working Party on Tuberculosis of the Spine (1974) A controlled trial of anterior spinal fusion and debridement in the surgical management of tuberculosis of the spine in patients on standard chemotherapy: A study in Hong Kong. Br J Surg 61:853–866

    PubMed  Google Scholar 

  13. Moon MS (1977) Spine update: tuberculosis of the spine. Spine 22:1791–1797

    Article  Google Scholar 

  14. Moon MS, Woo YK, Lee KS, et al (1995) Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine 20:1910–1916

    CAS  PubMed  Google Scholar 

  15. National Technic Steering Group of the Epidemiological Sampling Survey for Tuberculosis (2002) Report on the fourth national epidemiological sampling survey of tuberculosis in China. Chin J Tuberculos Respir Dis 25:3–7

    Google Scholar 

  16. Oga M, Arizono T, Takasita M, et al (1993) Evaluation of the risk of instrumentation as a foreign body in the spinal tuberculosis: clinical and biologic study. Spine 18:1890–1894

    CAS  PubMed  Google Scholar 

  17. Yilmaz C, Selek HY, Gurkan I, et al (1997) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am) 81A:1261–1267

    Google Scholar 

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Correspondence to Dadi Jin.

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This article was presented at the Conference of Eurospine 2001, Gothenburg, Sweden.

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Jin, D., Qu, D., Chen, J. et al. One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13, 114–121 (2004). https://doi.org/10.1007/s00586-003-0661-5

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