M Subbiah1, S Shiromi2, K Yegumuthu3. 1. Department of Orthopaedics and Spine Surgery, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport-Mattuthavani Ring Road, Chinna Anuppanadi, Madurai, Tamil Nadu, 625009, India. subbuorth@yahoo.co.in. 2. Department of Orthopaedics and Spine Surgery, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport-Mattuthavani Ring Road, Chinna Anuppanadi, Madurai, Tamil Nadu, 625009, India. 3. Department of Pathology, Velammal Medical College Hospital and Research Institute, Velammal Village, Airport-Mattuthavani Ring Road, Chinna Anuppanadi, Madurai, Tamil Nadu, 625009, India.
Abstract
BACKGROUND: Surgery in tubercular spondylodiscitis involves radical debridement and fusion by combined anterior and posterior or all posterior approaches with a posterolateral window with its associated morbidities. This study evaluates the outcome of a comprehensive treatment algorithm for thoracic and lumbar tubercular spondylodiscitis by a single-stage posterior transforaminal approach. METHODS: One hundred and twenty-six patients with tubercular spondylodiscitis between T1 and S1 who underwent posterior surgery with/without fusion by transforaminal approach with a minimum follow-up of 2 years were analyzed. Radiological outcome was assessed by documenting healing with magnetic resonance imaging/computed tomography and radiographical fusion, while clinical outcome was assessed by visual analog score (VAS) for pain and Frankel grading for neurological recovery. RESULTS: Of the 114 patients available for follow-up with a mean age of 53 years, complete radiological healing was observed in all patients (100%) with radiographical fusion in 97.4% and neurology recovered to Frankel E in all 37 patients with deficit. The preoperative VAS score of 9.2 improved significantly to 1.7 postoperatively, and all patients returned to their preoperative occupational activities at the final follow-up. CONCLUSION: This comprehensive treatment algorithm of single-stage posterior surgery by transforaminal approach in thoracic and lumbar tubercular spondylodiscitis provided good clinical and radiological outcomes. It aids in achieving the same surgical goals, obviating the need for extensive posterior or combined surgical approaches.
BACKGROUND: Surgery in tubercular spondylodiscitis involves radical debridement and fusion by combined anterior and posterior or all posterior approaches with a posterolateral window with its associated morbidities. This study evaluates the outcome of a comprehensive treatment algorithm for thoracic and lumbar tubercular spondylodiscitis by a single-stage posterior transforaminal approach. METHODS: One hundred and twenty-six patients with tubercular spondylodiscitis between T1 and S1 who underwent posterior surgery with/without fusion by transforaminal approach with a minimum follow-up of 2 years were analyzed. Radiological outcome was assessed by documenting healing with magnetic resonance imaging/computed tomography and radiographical fusion, while clinical outcome was assessed by visual analog score (VAS) for pain and Frankel grading for neurological recovery. RESULTS: Of the 114 patients available for follow-up with a mean age of 53 years, complete radiological healing was observed in all patients (100%) with radiographical fusion in 97.4% and neurology recovered to Frankel E in all 37 patients with deficit. The preoperative VAS score of 9.2 improved significantly to 1.7 postoperatively, and all patients returned to their preoperative occupational activities at the final follow-up. CONCLUSION: This comprehensive treatment algorithm of single-stage posterior surgery by transforaminal approach in thoracic and lumbar tubercular spondylodiscitis provided good clinical and radiological outcomes. It aids in achieving the same surgical goals, obviating the need for extensive posterior or combined surgical approaches.
Authors: Feyza Karagöz Güzey; Erhan Emel; N Serdar Bas; Selim Hacisalihoglu; M Hakan Seyithanoglu; Sabri Emin Karacor; Nezih Ozkan; Ibrahim Alatas; Baris Sel Journal: J Neurosurg Spine Date: 2005-12
Authors: Md Shah Alam; Kevin Phan; Rezaul Karim; Sharif Ahmed Jonayed; Hasan Khalid Md Munir; Shubhendu Chakraborty; Tashfique Alam Journal: J Spine Surg Date: 2015-12