Documente Academic
Documente Profesional
Documente Cultură
31]
Original Article
Abstract
Background: Approach for surgical treatment of thoracolumbar tuberculosis has been controversial. The aim of present study
is to compare the clinical, radiological and functional outcome of anterior versus posterior debridement and spinal fixation for the
surgical treatment of thoracic and thoracolumbar tuberculosis.
Materials and Methods: 70patients with spinal tuberculosis treated surgically between Jan2001 and Dec2006 were included
in the study. Thirty four patients (group I) with mean age 34.9 years underwent anterior debridement, decompression and
instrumentation by anterior transthoracic, transpleural and/or retroperitoneal diaphragm cutting approach. Thirty six patients
(groupII) with mean age of 33.6years were operated by posterolateral (extracavitary) decompression and posterior instrumentation.
Various parameters like blood loss, surgical time, levels of instrumentation, neurological recovery, and kyphosis improvement
were compared. Fusion assessment was done as per Bridwell criteria. Functional outcome was assessed using Prolo scale.
Mean followup was 26months.
Results: Mean surgical time in groupI was 5h 10min versus 4h 50min in groupII (P>0.05). Average blood loss in groupI was
900ml compared to 1100ml in groupII (P>0.05). In groupI, the percentage immediate correction in kyphosis was 52.27% versus
72.80% in groupII. Satisfactory bony fusion (grades I and II) was seen in 100% patients in groupI versus 97.22% in groupII.
Three patients in groupI needed prolonged immediate postoperative ICU support compared to one in groupII. Injury to lung
parenchyma was seen in one patient in groupI while the anterior procedure had to be abandoned in one case due to pleural
adhesions. Functional outcome (Prolo scale) in groupII was good in 94.4% patients compared to 88.23% patients in groupI.
Conclusion: Though the anterior approach is an equally good method for debridement and stabilization, kyphus correction is
better with posterior instrumentation and the posterior approach is associated with less morbidity and complications.
Key words: Anterior approach, extracavitary approach, posterior approach, Potts spine
Introduction
Website:
www.ijoonline.com
DOI:
10.4103/0019-5413.93682
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Single level
Two level
>Two level
Total
Thoracolumbar
(T11L2)
Group I
Group II
12
8
6
7
0
1
18
16
Total
42
22
6
70
Thoracic
(T4T10)
Group I
Group II
10
12
4
5
2
3
16
20
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Figure2: Preoperative lateral (a) and anteroposterior view Xrays (b) a 32yearold female with tuberculosis of D1112. Sagittal T2 WI (c) and
T1WI (d) and axial T2WI (e) MRI images show active tuberculosis with abscess formation and cord compression. This patient was treated by
posterior extrapleural approach with pedicular screwrod fixation (f) Postoperative Xrays (g and h) of the same patient show good decompression
and kyphosis correction. At 9months followup, solid bony fusion was seen on computed tomography axial and sagittal reconstruction (i and j)
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Results
GroupI
Preop Final postop GroupII Preop Final postop
(no. of
Frankel Frankel
(no. of Frankel Frankel
patients) score score
patients) score score
0
A
0
0
A
0
0
B
0
0
B
0
18
C
C=2patients
19
C
C=2patients
D=6patients
D=5patients
E=10patients
E=12patients
12
D
C=1patient
11
D
D=2patients
D=1patient
E=9patients
E=10patients
4
E
B=1patient
6
E
E=6patients
E=3patients
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Discussion
References
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