OUTCOME OF PARALLEL STAGE ANTERIOR AND POSTERIOR SURGERY FOR TUBERCULOUS PARAPLEGIA
Abstract
PURPOSE: To assess the neurological recovery in patients who underwent anterior debridement, fusion and posterior instrumentation and early rehabilitation. To assess the incidence of graft related complications. To study the extent of deformity correction and maintenance in these patients
METHODS: A prospective follow up of a cohort of patients who underwent combined anterior (anterior debridement and bone grafting) and posterior (posterior instrumentation and fusion) surgery was done IN LALITHA HOSPITAL GUNTUR in a period of aug 2018 to aug 2019
RESULTS. This study was done over a 1 year period from 2018 AUG- 2019 AUG.Of the 76 patients with tuberculosis of the spine 30 patients with Frankel A,B and C grade neurological deficits were included in the study. One patient had a follow up of only 2 months and thus was
excluded from the post operative evaluation.
CONCLUSION: In the cohort that was studied 89.6% showed good neurological recovery, the average loss of correction was 6.98° (0.20 to 35.90°) and the complication rate was reasonable. We conclude that Single stage anterior debridement, decompression and fusion with strut grafting and posterior stabilization and fusion permits early ambulation, shortens hospital stay and allows early rehabilitation. It does not interfere with neurological recovery. It allows deformity correction and maintains this correction at long term follow up.
Full Text:
PDFReferences
Dolin PJ, Raviglione MC, Kochi A: A review of current
epidemiological data and estimation of future tuberculosis
incidence and mortality. WHO /TB/93.173. Geneva: World
Health Organization; 1993.
Chakraborty AK: Prevalence and incidence of tuberculosis
infection and disease in India: a comprehensive review.
, WHO / TB / 97. 231, p 1-26 (+ attachment). Geneva:
World Health Organization.
Moon, Myung-Sang MD, PhD, FACS: Tuberculosis of the Spine:
Controversies and a New Challenge [Spine Update]. Spine 1997;
(15):1791-1797
Tuli SM: Results of treatment of spinal tuberculosis by “ middle
path regime” .J Bone Joint Surg.1975;57B (1):13-23
Chen WJ, Chen CH, Shih CH: Surgical treatment of tuberculosis
spondylitis. Acta Orthop Scand 1995; 66:137-42
Hodgson AR, Stock FE: 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] 1960;
:295-310
Rajasekaran S, Soundarapandian S: Progression of kyphosis in
tuberculosis of the spine treated by anterior arthrodesis. J Bone
Joint Surg [Am] 1989; 71:1314-23
Fifth report of the Medical Research Council Working Party on
Tuberculosis of the Spine, A five year assessment of controlled trials
of inpatient and out patient treatment and of Plaster of Paris jackets
for tuberculosis of the spine in children on standard chemotherapy.
Studies in Masan and Pusan, Korea. J Bone Joint Surg.1976; 58 B
(4):399-411
Eighth report of the Medical Research Council Working Party on
Tuberculosis of the Spine, A 10 year assessment of a controlled trial
comparing debridement and anterior spinal fusion in the
management of tuberculosis of the spine in patients on standard
chemotherapy in Hong Kong. J Bone Joint Surg [Br] 1982; 64B
(4):393- 398
Thirteenth report of the Medical Research Council Working Party
on Tuberculosis of the Spine, A 15-year assessment of controlled
trials of the management of tuberculosis of the spine in Korea and
Hong Kong. J Bone Joint Surg .1998; 80B:456-62
Bailey H.l, Gabriel M, Hodgson AR et al: Tuberculosis of the
spine in children. Operative findings and results in one hundred
consecutive patients treated by removal of the lesion and anterior
grafting. J Bone Joint Surg.1972; 54A:1633-1657
Chu C.B: Treatment of Spinal tuberculosis in Korea, using focal
debridement and interbody fusion. Clin Orthop.1967; 50:235-253
Hodgson, A.R. and Stock F.E: Anterior spinal fusion. A
preliminary communication on the radical treatment of Potts disease
and Potts Paraplegia. British J Surgery 1956; 44:266-275
Tuli S M et al: Tuberculosis of the spine. Acta Orthop Scand
; 38:445-458
Kemp H.B.S, Jackson J.W.’ Jeremiah J.D. and Cook J: Anterior
fusion of the spine for infective lesions in adults. J Bone Joint
Surg.1973;55B(4):715-734
Rajasekaran S. et al: Prediction of angle of gibbus deformity in
tuberculosis spine. J Bone Joint Surg.1987; (69):503-509
Puig Guri,J. :The formation and significance of vertebral
ankylosis in tuberculous spines. J Bone Joint Surg.1947; 29:136-
Nene A, Bhojraj S: Results of non surgical treatment of thoracic
spinal tuberculosis in adults. Spine J.2005; 5(1): 79-84
Medical Research Council Working Party on Tuberculosis of the
Spine: 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. British J Surg.1974;
: 853-866
Upadhyay SS, Sell P et al: Surgical management of spinal
tuberculosis in adults. Hong Kong operation compared with
debridement surgery for short and long term outcome of deformity.
Clin Orthop Relat Res. 1994; (302):173-82.
Fountain SS, Hsu LCS et al: Progressive kyphosis following solid
anterior spine fusion in children with tuberculosis of the spine. J
Bone Joint Surg.1975; 57A: 1104-7
Lifeso et al: Tuberculous spondylitis in Adults. J Bone Joint
Surg.1985; 67A (9): 1405-1413
Upadhyay SS, Sell P, Saji MJ: The effect of age on change in
deformity after radical resection and anterior arthrodesis for
tuberculosis of the spine. J.B.J.S. 1994; 76A:701-8
Bailey H.l, Gabriel M, Hodgson AR et al: Tuberculosis of the
spine in children. Operative findings and results in one hundred
consecutive patients treated by removal of the lesion and anterior
grafting. J.B.J.S.1972;54A: 1633-1657
Moon MS, Ha KY, Sun DH, Mon JL, Chung JW: Pott’s paraplegia
- 67 cases. Clin Orthop 1996; 323:122-8
Kohli SB: Radical surgical approach to spinal tuberculosis. J
Bone Joint Surg 1967; 49B:668-673
Goel MK: Treatment of Pott’s paraplegia by operation. J Bone
Joint Surg. 1967; 49B:674-681
Guirguis AR: Pott’s paraplegia. J Bone Joint Surg .1967; 49B:
-667
Martin NS: Pott’s paraplegia. J Bone Joint Surg.1971; 53B: 596-
Jain AK, Aggarwal A, Dhammi IK, Aggarwal PK, Singh S:
Extrapleural anterolateral decompression in tuberculosis of the
dorsal spine. J Bone Joint Surg Br. 2004; 86(7):1027-31
Oga, M.; Arizono, T.; Takasita, M.; and Sugioka, Y: Evaluation
of the risk of instrumentation as a foreign body in spinal
tuberculosis. Clinical and biological study. Spine 1993; 18: 1890-
Osman Guven et al: A single stage posterior approach and rigid
fixation for preventing kyphosis in treatment of spinal tuberculosis.
Spine 1994; 19(9): 1039-1043
Benli Y.T. Alanay et al: Comparison of Anterior instrumentation
Systems and the Results of Minimum 5 Years Follow – up in the
Treatment of Tuberculosis Spondylitis. Kobe J. Med. Sci.2004;
(6):167-180
G. D. Sundararaj, S. Behera, V. Ravi, K. Venkatesh, V. M.
Cherian, V. Lee: Role of posterior stabilisation in the management
of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg.
; 85B:100-6.
Yilmaz C et al: Anterior instrumentation for treatment of spinal
tuberculosis. J Bone Joint Surg.1999; 81A:1261-67
Laheri VJ, Badhe NP, Dewnany GT Single stage decompression,
anterior interbody fusion and posterior instrumentation for
tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord. 2001;
(8):429-36.
Moon MS, Woo YK, Lee KS, Ha KY, Kim SS, Sun DH: Posterior
instrumentation and anterior interbody fusion for tuberculous
kyphosis of dorsal and lumbar spines. Spine. 1995; 20(17):1910-6.
Ramani PS, Sharma A, Jituri S, Muzumdar DP:Anterior
instrumentation for cervical spine tuberculosis: An analysis of
surgical experience with 61 cases. Neurol India. 2005; 53(1):83-9.
Tuli SM: Tuberculosis of the skeletal system. 2nd Edition
Moon MS, Moon JL, et al: Pott’s paraplegia in patients with
severely deformed dorsal or dorsolumbar spines: treatment and
prognosis. Spinal cord. 2003; 41(3):164-71
Jain AK: Treatment of tuberculosis of the spine with neurological
complications. Clin Orthop Relat Res. 2002; (398): 75-84
Refbacks
- There are currently no refbacks.