Abstract
Purpose
There are few articles in the literature comparing outcomes between anterior and posterior instrumentation in the management of thoracic and lumbar spinal tuberculosis (TB).
Methods
Between January 2004 and December 2009, 217 adult patients, average age 39 (range 16–67) years with thoracic and lumbar spinal TB were treated by anterior radical debridement and fusion plus instrumentation, anterior radical debridement with fusion and posterior fusion with instrumentation, posterolateral debridement and fusion plus posterior instrumentation or transpedicular debridement and posterior fusion with instrumentation in a single- or two-stage procedure. We followed up 165 patients for 22–72 (mean 37) months. Of these, 138 underwent more than three weeks chemotherapy with isoniazid, rifampin, pyrazinamide and ethambutol, and the remaining 27 underwent operation for neurological impairment within six to 18 hours of the same chemotherapy regimen. In no case did relapse occur. Apart from eight patients with skip lesions treated by hybrid anterior and posterior instrumentation, anterior instrumentation was used in 74 patients (group A) and 83 patients (group B) were fixed posteriorly.
Results
In both groups, local symptoms were relieved significantly one to three weeks postoperatively; ten of 14 patients (71%) in group A and 14 of 19 (74%) in group B with neurological deficit had excellent or good clinical results (P > 0.05). Erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.7 mm/h, respectively, preoperatively to normal levels eight to 12 weeks postoperatively. Kyphosis degree was corrected by a mean of 11.5° in group A and 12.6° in group B, respectively (P < 0.01). Correction loss was 6.8° in group A and 6.1° in group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8%, respectively, at final follow-up (P > 0.05). Severe complications did not occur.
Conclusion
These results suggest that both anterior and posterior instrumentation attain good results for correction of the deformity and maintaining correction, foci clearance, spinal-cord decompression and pain relief in the treatment of thoracic and lumbar spinal TB providing that the opeartive indication is accurately identified. However, the posterior approach may be superior to anterior instrumentation to correct deformity and maintain that correction.
Similar content being viewed by others
References
Nagashima H, Yamane K, Nishi T et al (2010) Recent trends in spinal infections: retrospective analysis of patients treated during the past 50 years. Int Orthop 34:395–399
Jin D, Dongbin Qu, Chen J et al (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J 13:114–121
Swanson AN, Pappou IP, Cammisa FP et al (2006) Chronic infections of the spine: surgical indications and treatments. Clin Orthop Relat Res 444:100–106
Huang Qi-Shan, Zheng C, Yuezheng Hu et al (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33:1385–1390
Rajasekaran S, Shanmugasundaram TK (1987) Prediction of the angle of gibbus deformity in tuberculosis of the spine. J Bone Joint Surg Am 69:503–508
Karaeminogullari O, Aydinli U, Ozerdemoglu R et al (2007) Tuberculosis of the Lumbar Spine: Outcomes After Combined Treatment of Two-drug Therapy and Surgery. Orthopedics 30(1):55–59
Kim BJ, Ko HS, Lim Y et al (1993) The clinical study of the tuberculous spondylitis. J Korean Orthop Assoc 28:2221–2232
Benli IT, Kıs M, Akalın S et al (2000) The results of anterior radical debridement and anterior instrumentation in Pott’s disease and comparison with other surgical techniques. Kobe J Med Sci 46:39–68
Faraj AA (2001) Anterior instrumentation for the treatment of spinal tuberculosis (letter). J Bone Joint Surg Am 83A:463
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
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
Chen YC, Chang MC, Wang ST et al (2003) One-stage posterior surgery for treatment of advanced spinal tuberculosis. J Chin Med Assoc 66:411–417
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
Al-Sebai MW, Al-Khawashki H, Al-Arabi K et al (2001) Operative treatment of progressive deformity in spinal tuberculosis. Int Orthop 25:322–325
Lee Sun-Ho, Sung J-K, Park Y-M (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
Broner FA, Garland DE, Zigler JE (1996) Spinal infection in the immunocompromised host. Orthop Clin North Am 27:37–46
Altman GT, Altman DT, Frankovitch KF (1996) Anterior and posterior fusion for children with tuberculosis of the spine. Clin Orthop 325:225–231
Talu U, Gogus A, Ozturk C (2006) 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 19:554–559
Issack PS, Boachie-Adjei O (2011) Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop Jun 15 (Epub ahead of print) - doi:10.1007/s00264-011-1292-9
Jain Ak, Jain S (2011) Instrumented stabilization in spinal tuberculosis. Int Orthop Jul 1, (Epub ahead of print) - doi:10.1007/s00264-011-1296-5
Wang Z, Ge Z, Jin W et al (2007) Treatment of spinal tuberculosis with ultrashort-course chemotherapy in conjunction with partial excision of pathologic vertebrae. Spine J 7:671–681
Güven O, Kumano K, Yalcin S et al (1994) A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043
Domanic U, Hamzaoglu A, Sar C, Yavuzer Y (1993) Posterior fusion and instrumentation after anterior radical debridement and fusion in the surgical treatment of Pott’s disease. J Turkish Spine Surg 4:16–19
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
Chen WJ, Wu CC, Jung CH, Chen LH et al (2002) Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res 398:50–59
Teoman Benli İ, Acaroğlu E, Akalin S et al (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12:224–234
Zhao J, Lian XF, Hou TS et al (2007) Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. Int Orthop 31:859–863
Kim KS, Ko SH, Youm KS et al (1998) Anterior spinal instrumentation in treatment of spinal tuberculosis. J Korean Orthop Assoc 33:1560–1568
Author information
Authors and Affiliations
Corresponding author
Additional information
The Co-first authors are Yuan Zheng Ma and Xu Cui
Rights and permissions
About this article
Cite this article
Ma, Y.Z., Cui, X., Li, H.W. et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. International Orthopaedics (SICOT) 36, 299–305 (2012). https://doi.org/10.1007/s00264-011-1390-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00264-011-1390-8