Skip to main content

Osteotomized debridement versus curetted debridement in posterior approach in treating thoracolumbar tuberculosis: a comparative study

Abstract

Purpose

This study aimed to compare osteotomized debridement (OD) with traditional curetted debridement (CD) in treating thoracolumbar tuberculosis (TB).

Methods

A total of 188 patients were diagnosed with active thoracolumbar TB and underwent one-stage posterior surgery at our institution. Of the 188 patients, 85 patients were treated with OD, and 103 patients were treated with traditional CD. The patient information, laboratory results, imaging findings, and clinical effectiveness were, respectively, compared between the two groups.

Results

Group OD consumed less operation time and blood loss than group CD (P < 0.05 for both values). No significant difference in hospitalization time was found between the two groups (P > 0.05). The values of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) in both groups returned to the normal range within one month postoperatively. All patients had significant improvement in visual analog scale (VAS) and oswestry disability index (ODI) postoperatively. The mean fusion time in group OD was shorter than that in group CD (P < 0.05). There was no statistically significant difference in preoperative kyphotic angle between the two groups (P > 0.05), but group OD showed less correction loss than group CD at the final follow-up (P < 0.05). The rate of recurrence and surgery-related complications in group OD was lower than group CD.

Conclusions

Posterior OD, reconstruction with titanium mesh cages (TMCs), and instrumentation is feasible and effective in treating thoracolumbar TB. Compared with the traditional CD, OD can achieve radical lesion removal, more effective kyphosis correction, lower recurrence rate, and fewer complications.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3

Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Jain AK (2010) Tuberculosis of the spine: a fresh look at an old disease. J Bone Joint Surg Br 92:905–913. https://doi.org/10.1302/0301-620X.92B7.24668

    CAS  Article  PubMed  Google Scholar 

  2. Zhao J, Lian XF, Hou TS, Ma H, Chen ZM (2007) Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. Int Orthop 31:859–863. https://doi.org/10.1007/s00264-006-0253-1

    Article  PubMed  Google Scholar 

  3. 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 

  4. Qian J, Rijiepu A, Zhu B, Tian D, Chen L, Jing J (2016) Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis. Int Orthop 40:2081–2088. https://doi.org/10.1007/s00264-016-3234-z

    Article  PubMed  Google Scholar 

  5. Wu P, Luo C, Pang X, Xu Z, Zeng H, Wang X (2013) Surgical treatment of thoracic spinal tuberculosis with adjacent segments lesion via one-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion, a clinical study. Arch Orthop Trauma Surg 133:1341–1350. https://doi.org/10.1007/s00402-013-1811-9

    Article  PubMed  Google Scholar 

  6. Arora S, Sabat D, Maini L, Sural S, Kumar V, Gautam V, Gupta A, Dhal A (2012) Isolated involvement of the posterior elements in spinal tuberculosis: a review of twenty-four cases. J Bone joInt Surg Am 94:e151. https://doi.org/10.2106/jbjs.K.01464

    Article  PubMed  Google Scholar 

  7. 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 

  8. Mak KC, Cheung KM (2013) Surgical treatment of acute TB spondylitis: indications and outcomes. Eur Spine J 22(Suppl 4):603–611. https://doi.org/10.1007/s00586-012-2455-0

    Article  PubMed  Google Scholar 

  9. 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

    CAS  Article  PubMed  Google Scholar 

  10. Nene A, Bhojraj S (2005) Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J 5:79–84. https://doi.org/10.1016/j.spinee.2004.05.255

    Article  PubMed  Google Scholar 

  11. 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 

  12. Moon M (1997) Tuberculosis of the spine. Controversies New Challenge Spine 22:1791–1797. https://doi.org/10.1097/00007632-199708010-00022

    CAS  Article  PubMed  Google Scholar 

  13. Bhojraj S, Nene A (2002) Lumbar and lumbosacral tuberculous spondylodiscitis in adults. Redefining the indications for surgery. J Bone Joint Surg Br 84:530–534. https://doi.org/10.1302/0301-620x.84b4.12363

    CAS  Article  PubMed  Google Scholar 

  14. 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 

  15. Pandita A, Madhuripan N, Pandita S, Hurtado R (2020) Challenges and controversies in the treatment of spinal tuberculosis. J Clin Tuberculosis Other Mycobacterial Dis 19:100151. https://doi.org/10.1016/j.jctube.2020.100151

    Article  Google Scholar 

  16. 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

    CAS  Article  PubMed  Google Scholar 

  17. Zhang HQ, Lin MZ, Li JS, Tang MX, Guo CF, Wu JH, Liu JY (2013) One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series. Arch Orthop Trauma Surg 133:333–341. https://doi.org/10.1007/s00402-012-1669-2

    Article  PubMed  Google Scholar 

  18. Zhang P, Peng W, Wang X, Luo C, Xu Z, Zeng H, Liu Z, Zhang Y, Ge L (2016) Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. Br J Neurosurg 30:666–671. https://doi.org/10.1080/02688697.2016.1206182

    Article  PubMed  Google Scholar 

  19. Benli IT, Kaya A, Acaroglu E (2007) Anterior instrumentation in tuberculous spondylitis: is it effective and safe? Clin Orthop Relat Res 460:108–116. https://doi.org/10.1097/BLO.0b013e318065b70d

    Article  PubMed  Google Scholar 

  20. Assaghir YM, Refae HH, Alam-Eddin M (2016) Anterior versus posterior debridement fusion for single-level dorsal tuberculosis: the role of graft-type and level of fixation on determining the outcome. Eur Spine J 25:3884–3893. https://doi.org/10.1007/s00586-016-4516-2

    Article  PubMed  Google Scholar 

  21. 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 

  22. 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 

  23. 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 

  24. Rajasekaran S, Kanna R, Shetty A (2015) History of spine surgery for tuberculous spondylodiscitis. Unfallchirurg. https://doi.org/10.1007/s00113-015-0093-9

    Article  PubMed  Google Scholar 

  25. Lee S, Sung J, Park Y (2006) Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. J Spinal Disord Tech 19:595–602. https://doi.org/10.1097/01.bsd.0000211241.06588.7b

    Article  PubMed  Google Scholar 

  26. Broner FA, Garland DE, Zigler JE (1996) Spinal Infections in the Immunocompromised Host. Orthop Clin North Am 27:37–46. https://doi.org/10.1016/s0030-5898(20)32048-4

    CAS  Article  PubMed  Google Scholar 

  27. Zhang H, Guo C, Xiao X, Long W, Deng Z, 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 20:263–267. https://doi.org/10.1097/01.bsd.0000211281.68400.1b

    Article  PubMed  Google Scholar 

  28. 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 39:E40-48. https://doi.org/10.1097/brs.0000000000000053

    Article  PubMed  Google Scholar 

  29. Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831. https://doi.org/10.1097/00007632-198311000-00003

    CAS  Article  PubMed  Google Scholar 

  30. Oguz E, Sehirlioglu A, Altinmakas M, Ozturk C, Komurcu M, Solakoglu C, Vaccaro A (2008) A new classification and guide for surgical treatment of spinal tuberculosis. Int Orthop 32:127–133. https://doi.org/10.1007/s00264-006-0278-5

    CAS  Article  PubMed  Google Scholar 

Download references

Funding

The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations

Authors

Contributions

Conceptualization: KC. Methodology: KC, SM. Formal analysis and investigation: ZZ, JX. Writing—original draft preparation: SM, CW. Writing—review and editing: ZZ, PD. Resources: SM, SH, WD. Supervision: ZW.

Corresponding author

Correspondence to Kai Cao.

Ethics declarations

Conflict of interest

There are no conflicts of interest for this manuscript, and the authors have no relevant financial or non-financial interests to disclose.

Ethics approval

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

Consent for publication

All authors got the consent for publication.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ma, S., Zhou, Z., Wan, Z. et al. Osteotomized debridement versus curetted debridement in posterior approach in treating thoracolumbar tuberculosis: a comparative study. Eur Spine J 31, 473–481 (2022). https://doi.org/10.1007/s00586-021-07075-w

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-07075-w

Keywords

  • Spinal tuberculosis
  • Debridement
  • Kyphosis
  • Osteotomy
  • Surgical treatment