Surgical Management for Spinal Tuberculosis: A Review

Title: Surgical Management for Spinal Tuberculosis: A Review

Authors: Dr Ahsan Shaik Mohammed, Dr Xiaozhong Zhou, Dr Zhentao Zhou, Dr Bingchen Shan M.B.B.S (M.S Orthopedic)

DOI: https://dx.doi.org/10.18535/jmscr/v5i3.66

Abstract

Spinal tuberculosis (TB) incidence in both developing and developed countries has dramatically increased, owing to the increase of HIV infection and drug resistance ^[¹^,2]. Antituberculous chemotherapy is proven to be ineffective in the prevention of paraplegia, kyphosis and instability of vertebrae ^[³^]. Surgical procedures are a supplementary of chemotherapy playing an important role in the treatment of patients with neurological deficit, caseous abscesses or sequestrum formation, unstable spine and kyphotic deformity[4, 5]. Current surgical approaches mainly advocated by the surgeons are anterior approach alone, posterior approach alone and combined approach. To date, consensus as to whether anterior or posterior approach or combined approach should be applied in the treatment of spinal TB is not available in the literature. Based on analysis of many literatures, an anterior radical debridement and strut grafting with instrumentation allow reaching the focal point of the disease directly, effective debridement of the focal point. But, it also has many disadvantages which includes great surgical invasion, crinose complications and comparatively ineffective correction of instability and lordosis. Though a posterior debridement and strut grafting with instrumentation may not fit for the patients with prevertebral or paravertebral huge abscess or large vertebral destruction, it is safer, technically easier, effective kyphosis correction and less potential intra- and post- operative complication which can be associated with the anterior and combined posterior procedures. The combined approach owns both advantages of anterior and posterior surgery suitable for patients with extreme prevertebral or paravertebral huge abscess or large vertebral destruction. But, it is not advisable for every patient, as it has a longer operation time, longer healing duration, and higher incidence of surgical complications. Consequently, the operating management choices for spinal TB should follow to the needs of the individual patient. With the continuous development of posterior techniques, the posterior debridement achieves the role of anterior debridement to a certain extent. Based on analysis of the literatures, posterior debridement and bone grafting fusion with posterior instrumentation mentioned by more and more surgeons and acquired favorable outcomes can be the superior surgical approach to spinal TB at early metaphase.

References

1. Polley, P. and R. Dunn, Noncontiguous spinal tuberculosis: incidence and management. European Spine Journal, 2009. 18(8): p. 1096-1101.

2. Shi T, Zhang Z, Dai F, Zhou Q, He Q, Luo F, Hou T, Xu J. Retrospective Study of 967 Patients With Spinal Tuberculosis. Orthopedics. 2016; 39: p. 838-843.

3. Rajasekaran, S. and S. Soundarapandian, Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. The Journal of Bone & Joint Surgery, 1989. 71(9): p. 1314-1323.

4. Lee, S.-H., J.-K. Sung, and Y.-M. Park, Single-stage transpedicular decompression and posterior instrumentation in treatment of thoracic and thoracolumbar spinal tuberculosis: a retrospective case series. Journal of spinal disorders & techniques, 2006. 19(8): p. 595-602.

5. Rajasekaran, S., Kyphotic deformity in spinal tuberculosis and its management. International orthopaedics, 2012. 36(2): p. 359-365.

6. Karaeminogullari, O., et al., Tuberculosis of the lumbar spine: outcomes after combined treatment of two-drug therapy and surgery. Orthopedics, 2007. 30(1): p. 55-59.

7. Sun, L., et al., One-stage Posterior Surgical Treatment for Lumbosacral Tuberculosis With Major Vertebral Body Loss and Kyphosis. Orthopedics, 2013. 36(8): p. e1082-e1090.

8. Garg, R.K. and D.S. Somvanshi, Spinal tuberculosis: a review. The journal of spinal cord medicine, 2011. 34(5): p. 440-454.

9. Velivela K, Rajesh A. Paradoxical response in spinal tuberculosis: Lessons learnt. Journal of Neurosciences in Rural Practice. 2016;7(2):206-209. .

10. Moon, M.-S., Tuberculosis of spine—contemporary thoughts on current issues and perspective views. Current Orthopaedics, 2007. 21(5): p. 364-379.

11. Rasouli MR, Mirkoohi M, Vaccaro AR, Yarandi KK, Rahimi-Movaghar V. Spinal Tuberculosis: Diagnosis and Management. Asian Spine J. 2012.6(4): p. 294-308

12. Yusof, M.I., et al., Spinal tuberculosis: the association between pedicle involvement and anterior column damage and kyphotic deformity. Spine, 2009. 34(7): p. 713-717.

13. Jain, A.K., et al., Kyphosis in spinal tuberculosis–prevention and correction. Indian journal of orthopaedics, 2010. 44(2): p. 127.

14. Hodgson, A., et al., Anterior spinal fusion the operative approach and pathological findings in 412 patients with pott's disease of the spine. British Journal of Surgery, 1960. 48(208): p. 172-178.

15. Hirakawa, A., et al., Surgical outcome of 2-stage (posterior and anterior) surgical treatment using spinal instrumentation for tuberculous spondylitis. Journal of spinal disorders & techniques, 2010. 23(2): p. 133-138.

16. Tin Z-N M. Preliminary Report of Instrumentation in tuberculosis us Lumbosacral Spine. Malaysian Orthopaedic Journal. 2014;8(3): p.15-21

17. Tuli, S., Tuberculosis of the spine: a historical review. Clinical orthopaedics and related research, 2007. 460: p. 29-38.

18. Lee KY. Comparison of Pyogenic Spondylitis and Tuberculous Spondylitis.Asian Spine Journal. 2014.8(2): p.216-223.

19. Brito, J. S. D., Tirado, A., & Fernandes, Surgical Treatment of Spinal Tuberculosis Complicated with Extensive ABSCESS. The Iowa Orthopaedic Journal, 2014.(34), p.129–136.

20. Darbyshire, J., A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong-Thirteenth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, 1998. 80(3): p. 456-462.

21. BAILEY, H.L., 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. The Journal of Bone & Joint Surgery, 1972. 54(8): p. 1633-1657.

22. Park H-Y, Lee S-H, Park S-J, Kim E-S, Lee C-S, Eoh W. Surgical Management with Radiation Therapy for Metastatic Spinal Tumors Located on Cervicothoracic Junction : A Single Center Study. Journal of Korean Neurosurgical Society. 2015;57(1):42-49..

23. Zhao, J., et al., Anterior debridement and bone grafting of spinal tuberculosis with one-stage instrumentation anteriorly or posteriorly. International orthopaedics, 2007. 31(6): p. 859-863.

24. Qureshi MA, Khalique AB, Afzal W, Pasha IF, Aebi M. Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis. European Spine Journal. 2013.22(4): p.618-623.

25. Li, M., et al., One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation. The Spine Journal, 2011. 11(8): p. 726-733.

26. Benli, I.T., A. Kaya, and E. Acaroglu, Anterior instrumentation in tuberculous spondylitis: is it effective and safe? Clinical orthopaedics and related research, 2007. 460: p. 108-116.

27. Benli, I., et al., The results of anterior radical debridement and anterior instrumentation in Pott's disease and comparison with other surgical techniques. The Kobe journal of medical sciences, 2010. 46(1-2): p. 39-68.

28. Singh S, K.V ,et al,. Evaluation of Role of Anterior Debridement and Decompression of Spinal Cord and Instrumentation in Treatment of Tubercular Spondylitis. Asian Spine Journal. 2012.6(3) : p.183-193.

29. Prabhakar, M. and T. Thakker, Anterior decompression for cervicothoracic pathology: a study of 14 patients. The journal of spinal cord medicine, 2006. 29(2): p. 163.

30. Flouzat-L,C-H, et al,. Analysis of intraoperative difficulties and management of operative complications in revision anterior exposure of the lumbar spine: a report of 25 consecutive cases.European Spine Journal. 2013;22(4):766-774.

31. Zhang, H., et al., Treatment of lumbosacral spinal tuberculosis by one-stage anterior debridement and fusion combined with dual screw-rod anterior instrumentation underneath the iliac vessel. BMC Musculoskeletal Disorders. 2016.17: p.49.

32. Garst, R.J., Tuberculosis of the spine: a review of 236 operated cases in an underdeveloped region from 1954 to 1964. Journal of Spinal Disorders & Techniques, 1992. 5(3): p. 286-300.

33. Lehmer, S.M., A.D. Steffee, and R.W. Gaines Jr, Treatment of L5-S1 spondyloptosis by staged L5 resection with reduction and fusion of L4 onto S1 (Gaines procedure). Spine, 1994. 19(17): p. 1916-1924.

34. Zhang, H., et al., One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach. European Spine Journal, 2013. 22(3): p. 616-623.

35. Jiang, H., et al., Anterior transsternal approach for treatment of upper thoracic vertebral tuberculosis. Orthopaedic surgery, 2010. 2(4): p. 305-309.

36. Zaveri, G.R. and S.S. Mehta, Surgical treatment of lumbar tuberculous spondylodiscitis by transforaminal lumbar interbody fusion (TLIF) and posterior instrumentation. Journal of spinal disorders & techniques, 2009. 22(4): p. 257-262.

37. Garg N, V.R. et al., Minimally Invasive Surgical Approaches in the Management of Tuberculosis of the Thoracic and Lumbar Spine. Clinical Orthopaedics and Related Research. 2014.472(6): p.1855-1867.

38. Tuli SM. Historical aspects of Pott’s disease (spinal tuberculosis) management. European Spine Journal. 2013.22(4): p.529-538.

39. Ma, Y.Z., et al., Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. International orthopaedics, 2012. 36(2): p. 299-305.

40. Oga, M., et al., Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis: clinical and biologic study. Spine, 1993. 18(13): p. 1890-1894.

41. Zhang, H.-Q., et al., One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of cervicothoracic spinal tuberculosis with kyphosis in children: a preliminary report. Child's Nervous System, 2011. 27(5): p. 735-742.

42. Zhang, H.-q., et al., Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF). Archives of orthopaedic and trauma surgery, 2012. 132(6): p. 751-757.

43. Zhang, H., et al., A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. International orthopaedics, 2012. 36(2): p. 293-298.

44. Zeng, Y., et al., Clinical and radiographic evaluation of posterior surgical correction for the treatment of moderate to severe post-tuberculosis kyphosis in 36 cases with a minimum 2-year follow-up: Clinical article. Journal of Neurosurgery: Spine, 2012. 16(4): p. 351-358.

45. Zhang, H.-q., et al., One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series. Archives of orthopaedic and trauma surgery, 2013. 133(3): p. 333-341.

46. Chacko, A.G., R.K. Moorthy, and M.J. Chandy, The transpedicular approach in the management of thoracic spine tuberculosis: a short-term follow up study. Spine, 2004. 29(17): p. E363-E367.

47. Issack, P.S. and O. Boachie-Adjei, Surgical correction of kyphotic deformity in spinal tuberculosis. International orthopaedics, 2012. 36(2): p. 353-357.

48. Wang, Y., et al., Posterior-only multilevel modified vertebral column resection for extremely severe Pott’s kyphotic deformity. European Spine Journal, 2009. 18(10): p. 1436-1441.

49. Bezer, M., et al., Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion. Journal of spinal disorders & techniques, 2005. 18(5): p. 425-429.

50. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. Journal of Spine Surgery. 2015;1(1): p.2-18.

51. 51. Pu, X., et al., A posterior versus anterior surgical approach in combination with debridement, interbody autografting and instrumentation for thoracic and lumbar tuberculosis. International orthopaedics, 2012. 36(2): p. 307-313.

52. Ekinci S, Ersen O, Ekinci GH. Grade-III Paraplegia in Spinal Tuberculosis.Journal of Clinical and Diagnostic Research : JCDR. 2015.9(4):RL01-RL02.

53. Jain, A., et al., Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. Journal of Bone & Joint Surgery, British Volume, 2008. 90(11): p. 1477-1481.

54. Wang X, Li J, Lü G, Wang B, Lu C, Kang Y. Single-stage posterior instrumentation and anterior debridement for active tuberculosis of the thoracic and lumbar spine with kyphotic deformity. International Orthopaedics. 2012.36(2):373-380.

55. Talu, U., et al., The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases. Journal of spinal disorders & techniques, 2006. 19(8): p. 554-559.

56. Hanna, M.D., et al., Percutaneous drainage of tuberculous iliopsoas abscesses under image guidance. Australasian radiology, 1999. 43(4): p. 444-447.

57. Dinç, H., et al., Image-guided Percutaneous Drainage of Tuberculous Iliopsoas and Spondylodiskitic Abscesses: Midterm Results 1. Radiology, 2002. 225(2): p. 353-358.

58. Tofuku K, Koga H, Komiya S. Percutaneous Drainage Combined with Hyperbaric Oxygen Therapy for Pyogenic Spondylitis with Iliopsoas Abscess.Asian Spine Journal. 2014.8(3):253-259.

59. Oskouian Jr, R.J., J.P. Johnson, and J.J. Regan, Thoracoscopic microdiscectomy. Neurosurgery, 2002. 50(1): p. 103-109.

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Abstract

Call For Paper Volume 12 Issue 12 December 2024

JMSCR Menu

Impact Factor SJIF 2024: 7.892

Crossref - DOI

Editorial Policy

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