Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis.
ABSTRACT Results of single-stage anterior autogenous bone grafting and instrumentation for spinal tuberculosis were reported.
To determine the efficacy of anterior instrumentation following radical debridement and autogenous bone grafting in patients with spinal tuberculosis over a 3-year period at a single institution.
Patients with spinal tuberculosis have been not always successfully treated by radical debridement and bone grafting with or without supplementary posterior instrumentation and fusion, although most surgeons use posterior instrumentation to support anterior strut grafts.
In this prospective study, the authors evaluated 39 patients (22 male and 17 female; average age, 48 years) with spinal tuberculosis, who underwent single-stage anterior radical debridement, autogenous bone grafting, and instrumentation. The average follow-up period was 39.9 months (range, 30-54 months).
A solid fusion was achieved in all cases; there were 2 cases of draining fistula formation. Of all 28 patients with preoperative kyphosis, the deformity was corrected from an average of 13.5 degrees on admission to an average of 1.9 degrees after surgery. No significant loss of deformity correction was noted in these patients. There was no other recurrence of the tuberculous infection.
The authors think that the single-stage anterior autogenous bone grafting and instrumentation are a safe and effective method in the surgical management of spinal tuberculosis.
Article: Tuberculosis of spine.Acta Orthopaedica Scandinavica 02/1967; 38(4):445-58.
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ABSTRACT: BACKGROUND: Six men and seven women, aged 62 years, bedridden due to back pain from a septic spondylitis in the thoracolumbar region and not responding to conservative treatment, were operated on with transpedicular stabilisation of the affected segments to enhance mobilisation. All patients experienced immediately reduced back pain, allowing them to leave their bed and start mobilisation during the first postoperative day. At follow-up after a mean of 29 months (range 13-60 months) only one was using analgesics. RESULTS: Nine of the 11 patients with pathological neurology at surgery had improved, none had deteriorated, and all were ambulatory without bladder or bowel disturbances. Seven had achieved a solid interbody fusion, with a continued radiographic decrease in the spondylitic change in the rest, indicating that a progressive interbody fusion was in progress. Three individuals had increased kyphosis, a mean of 11 deg compared with the postoperative radiographs.Archives of Orthopaedic and Trauma Surgery 01/2003; 122(9-10):522-5. · 1.36 Impact Factor
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ABSTRACT: We present a prospective study of patients with tuberculosis of the dorsal, dorsolumbar and lumbar spine after combined anterior (radical debridement and anterior fusion) and posterior (instrumentation and fusion) surgery. The object was to study the progress of interbody union, the extent of correction of the kyphosis and its maintenance with early mobilisation, and the incidence of graft and implant-related problems. The American Spinal Injury Association (ASIA) score was used to assess the neurological status. The mean preoperative vertebral loss was highest (0.96) in the dorsal spine. The maximum correction of the kyphosis in the dorsolumbar spine was 17.8 degrees. Loss of correction was maximal in the lumbosacral spine at 13.7 degrees. All patients had firm anterior fusion at a mean of five months. The incidence of infection was 3.9% and of graft-related problems 6.5%. We conclude that adjuvant posterior stabilisation allows early mobilisation and rehabilitation. Graft-related problems were fewer and the progression and maintenance of correction of the kyphosis were better than with anterior surgery alone. There is no additional risk relating to the use of an implant either posteriorly or anteriorly even when large quantities of pus are present.Journal of Bone and Joint Surgery - British Volume 02/2003; 85(1):100-6. · 2.69 Impact Factor