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Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?

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Abstract

Purpose

The purpose of this study was to present our experience in treating dorso-lumbar tuberculosis by one-stage posterior circumferential fusion and to compare this group with a historical group treated by anterior debridement followed by postero-lateral fusion and stabilization.

Methods

Between 2003 and 2008, 32 patients with active spinal tuberculosis were treated by one-stage posterior circumferential fusion and prospectively followed for a minimum of two years. Pain severity was measured using Visual Analogue Scale (VAS). Neurological assessment was done using the Frankel scale. The operative data, clinical, radiological, and functional outcomes were also compared to a similar group of 25 patients treated with anterior debridement and fusion, followed 10–14 days later by posterior stabilization and postero-lateral fusion.

Results

The mean operative time and duration of hospital stay were significantly longer in the two-stage group. The mean estimated blood loss was also larger, though insignificantly, in the two-stage group. The incidence of complications was significantly lower in the one-stage group. At final follow-up, all 34 patients with pre-operative neurological deficits showed at least one Frankel grade of neurological improvement, all 57 patients showed significant improvement of their VAS back pain score, the mean kyphotic angle has significantly improved, all patients achieved solid fusion and 43 (75.4%) patients returned to their pre-disease activity level or work.

Conclusion

Instrumented circumferential fusion, whether in one or two stages, is an effective treatment for dorso-lumbar tuberculosis. One-stage surgery, however, is advantageous because it has lower complication rate, shorter hospital stay, less operative time and blood loss.

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References

  1. Nunn JF (1996) Ancient Egyptian medicine. British Museum Press, London

    Google Scholar 

  2. Roaf R, Kirkaldy-Willis WH, Cathro AJM (1959) Surgical treatment of bone and joint tuberculosis. E & S Livingstone, Edinburgh

    Google Scholar 

  3. Hibbs RA (1911) An operation for progressive spinal deformities. NY Med J 93:1013

    Google Scholar 

  4. Albee FH (1911) Transplantation of a portion of the tibia into the spine for Pott's disease: a preliminary report. JAMA 57:885

    Article  Google Scholar 

  5. Ito H, Tsuchiya J, Asami G (1934) A new radical operation for Pott’s disease. J Bone Jt Surg Br 16:499–515

    Google Scholar 

  6. Capener N (1954) The evolution of lateral rhachotomy. J Bone Jt Surg Br 36:173–179

    Google Scholar 

  7. Seddon HJ (1956) Pott's paraplegia. In: Platt H (ed) Modern trends in orthopaedics (second series). Butterworth, London

    Google Scholar 

  8. Hodgson AR, Stock FE (1956) Anterior spinal fusion a preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. Br J Surg 44:266

    Article  PubMed  CAS  Google Scholar 

  9. Hodgson AR, Stock F, Hodgson AR, Stock FE (1960) Anterior spine fusion for the treatment of tuberculosis of the spine: the operative findings and results of treatment of the first one hundred cases. J Bone Jt Surg 42 A:295

    Google Scholar 

  10. Korkusuz F, Islam C, Korkusuz Z (1997) Prevention of postoperative late kyphosis in Pott's disease by anterior decompression and intervertebral grafting. World J Surg 21:524–528

    Article  PubMed  CAS  Google Scholar 

  11. Yilmaz C, Selek HY, Gurkan I, Erdemli B, Korkusuz Z (1999) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Jt Surg 81A:1261

    Google Scholar 

  12. Benli IT, Kiş M, Akalin S, Citak M, Kanevetçi S, Duman E (2000) The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques. Kobe J Med Sci Apr 46(1–2):39–68

    CAS  Google Scholar 

  13. Benli IT, Alanay A, Akalin S, Kiş M, Acaroğlu E, Ateş B, Aydin E (2004) Comparison of anterior instrumentation systems and the results of minimum 5 years follow-up in the treatment of tuberculosis spondylitis. Kobe J Med Sci 50(5–6):167–180

    PubMed  Google Scholar 

  14. Jin D, Qu D, Chen J, Zhang H (2004) One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J Mar 13(2):114–121, Epub 2003 Dec 18

    Article  Google Scholar 

  15. Talu U, Gogus A, Ozturk C, Hamzaoglu A, Domanic U (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(8):554–559

    Article  PubMed  Google Scholar 

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

  17. Wang B, Ozawa H, Tanaka Y, Matsumoto F, Aizawa T, Kokubun S (2006) One-stage lateral rhachotomy and posterior spinal fusion with compression hooks for Pott’s paralysis in the elderly. J Orthop Surg 14(3):310–314

    CAS  Google Scholar 

  18. Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P (2008) Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Jt Surg Br 90(11):1477–1481

    Article  CAS  Google Scholar 

  19. Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q (2009) One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop Oct 33(5):1385–1390

    Article  Google Scholar 

  20. Ye M, Li JQ, Zou Y, Wang JG, Wang K, Zhou DS (2009) One stage anterior and posterior fusion and posterior fixation for the treatment of thoracic and lumbar spinal tuberculosis. Zhongguo Gu Shang 22(1):23–25

    PubMed  Google Scholar 

  21. Jain AK, Jain S (2011) Instrumented stabilization in spinal tuberculosis. Int Orthop. Jul 1. [Epub ahead of print]

  22. Frankel HL, Hancock DO, Hyslop G, Melzak J, Michaelis LS, Ungar GH, Vernon JD, Walsh JJ (1969) The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Paraplegia 7:179–192

    Article  PubMed  CAS  Google Scholar 

  23. Medical Research Council (1999) Five-year 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 23:73–81

    Article  Google Scholar 

  24. Heary RF, Bono CM (2002) Circumferential fusion for spondylolisthesis in the lumbar spine. Neurosurg Focus 13(1):E3

    Google Scholar 

  25. Christensen FB, Hansen ES, Eiskjaer SP, Høy K, Helmig P, Neumann P, Niedermann B, Bünger CE (2002) Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients. Spine (Phila Pa 1976) 27(23):2674–2683

    Google Scholar 

  26. Madan SS, Boeree NR (2003) Comparison of instrumented anterior interbody fusion with instrumented circumferential lumbar fusion. Eur Spine J 12:567–575

    Article  PubMed  CAS  Google Scholar 

  27. Gertzbein SD, Betz R, Clements D et al (1996) Semirigid instrumentation in the management of lumbar spinal conditions combined with circumferential fusion. A multicenter study. Spine 21:1918–1926

    Article  PubMed  CAS  Google Scholar 

  28. Gertzbein SD, Hollopeter M, Hall SD (1998) Analysis of circumferential lumbar fusion outcome in the treatment of degenerative disc disease of the lumbar spine. J Spinal Disord 11:472–478

    Article  PubMed  CAS  Google Scholar 

  29. Qu DB, Jin DD, Chen JT, Feng L, Jiang JM, Wang JX (2003) One-stage surgical management for spinal tuberculosis. Zhonghua Yi Xue Za Zhi 83(2):110–3

    PubMed  Google Scholar 

  30. He Q, Xu J (2011) Comparison between the antero-posterior and anterior approaches for treating L5-S1 vertebral tuberculosis. Int Orthop. Jul 7. [Epub ahead of print]

  31. Jain AK (398) Treatment of tuberculosis of the spine with neurologic complications. Clin Orthop Relat Res 398:75–84

    Article  Google Scholar 

  32. Mehta JS, Bhojraj SY (2001) Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies. J Bone Joint Surg Br 83:859–863

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  34. Niemeyer T, Bövingloh AS, Halm H, Liljenqvist U (2004) Results after anterior–posterior lumbar spinal fusion: 2–5 years follow-up. Int Orthop 28:298–302

    Article  PubMed  Google Scholar 

  35. Benli IT, Acaroğlu E, Akalin S, Kiş M, Duman E, Un A (2003) Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 12:224–234

    PubMed  Google Scholar 

  36. Govender S (2002) The outcome of allografts and anterior instrumentation in spinal tuberculosis. Clin Orthop Relat Res 398:60–66

    Article  PubMed  Google Scholar 

  37. Christodoulou AG, Givissis P, Karataglis D, Symeonidis PD, Pournaras J (2006) Treatment of tuberculous spondylitis with anterior stabilization and titanium cage. Clin Orthop Relat Res 444:60–65

    Article  PubMed  Google Scholar 

  38. Özdemir HM, Us AK, Oğün T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine 28:474–479

    PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Assiut University Medical School, Assiut, 71511, Egypt

    Mohammad Mostafa El-Sharkawi & Galal Zaki Said

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  1. Mohammad Mostafa El-Sharkawi
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  2. Galal Zaki Said
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Correspondence to Mohammad Mostafa El-Sharkawi.

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El-Sharkawi, M.M., Said, G.Z. Instrumented circumferential fusion for tuberculosis of the dorso-lumbar spine. A single or double stage procedure?. International Orthopaedics (SICOT) 36, 315–324 (2012). https://doi.org/10.1007/s00264-011-1401-9

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  • DOI: https://doi.org/10.1007/s00264-011-1401-9

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