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PubMed2005

Single-stage anterior autogenous bone grafting and instrumentation in the surgical management of spinal tuberculosis.

STUDY DESIGN: Results of single-stage anterior autogenous bone grafting and instrumentation for spinal tuberculosis were reported. OBJECTIVE: 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. SUMMARY OF BACKGROUND DATA: 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. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

Adult↗
PubMed2003

Cortical allografts in spinal tuberculosis.

One-hundred-twenty-three patients with neurological deficit due to spinal tuberculosis underwent anterior spinal decompression and anterior column reconstruction with fresh-frozen femoral allograft. Fifty-two patients with a follow-up of more than 5 years were evaluated to assess the incorporation and the efficacy of allograft in maintaining correction. The allograft was incorporated in 49 patients at a mean follow-up of 6.5 (5.3-8.2) years. Complete neurological recovery occurred in 39 patients. The mean pre-operative kyphosis of 37 degrees (15 degrees -67 degrees ) was corrected to 18 degrees (5 degrees -45 degrees ). Fresh-frozen allografts are a suitable alternative to autologous rib and iliac crest grafts in the treatment of spinal tuberculosis.

Adult↗
PubMed1992

Evaluation of radiological investigations in spinal tuberculosis.

Thirty-four cases of spinal tuberculosis were investigated by plain radiography, computerised tomography and myelography followed by computerised tomography. All the patients were operated on and the findings compared with the results of the investigations.

Adolescent↗
PubMed2004

The results of rehabilitation on motor and functional improvement of the spinal tuberculosis.

OBJECTIVES: To evaluate the result of rehabilitation on motor and functional improvement in spinal tuberculosis. METHOD: Prospective case study. Data were collected from 47 patients with spinal tuberculosis medically and/or surgically treated, and rehabilitated over 6 months of period, after spinal decompression and fusion. The main outcome measures were motor development of the patients who were evaluated at the beginning, in the 1st week, in the 3rd month, and in the 6th month. Functional development of the patients was evaluated at the beginning and in the 6th month. Functional assessment was made according to Modified Barthel Index (MBI), and motor examination was made according to American Spinal Injury Association (ASIA). RESULTS: The study population consisted of 47 patients (22 males and 25 females) mean aged 37.9 +/- 18.3 years (range 5-76 years). The most common site of spinal tuberculosis was the thoracic region. Localized back pain, paraparesis, sensory dysfunction and fever were typical clinical manifestations. Surgical management was performed as anterior or posterior drainage of abscess and/or stabilization of the spine. The rehabilitation program was performed in all patients during the preoperative, early postoperative and late postoperative 6 month periods. Muscle-strengthening exercises on necessary localization such as pectoral, abdominal, lower extremities; truncal and sacrospinal extensors were started for the rehabilitation. The motor score for the lower limbs and the MBI scores for activities of daily living (ADL) and mobility improved significantly (P < 0.001). The self-care and mobility categories of the MBI on admission; were 14.8% severely dependent and 10.6% independent. However, at the end of the rehabilitation program, 4.2% were severely dependent and 70.2% independent. IN CONCLUSION: Early diagnosis and appropriate medical and/or surgical treatment together with a rehabilitation program will improve the life quality of patients with spinal tuberculosis.

Activities of Daily Living↗
PubMed2003

[One-stage surgical management for spinal tuberculosis].

OBJECTIVE: To evaluate the clinical efficacy of one-stage surgical management for spinal tuberculosis. METHODS: Fifty-seven patients with thoracic, thoracolumbar and lumbar spinal tuberculosis were treated surgically by a single stage procedure from Jan 1996 to Jan 2001, including anterior resection, interbody outografting and anterior instrumentation in 35 cases, posterior debridement and posterior instrumentation in 16 cases, and posterior instrumentation and anterior resection plus interbody autografting in 6 cases. Titanium-alloy spinal implants were used in 38 cases and stainless steel implants in other 19 cases. Except for three patients, other 54 patients were followed up for one to five years (mean 2.2 years). RESULTS: All these patients had their incision healed by first intention without chronic infection or sinus formation, and no recurrence of spinal tuberculosis was noted in any patient during the follow-up period. Kyphosis correction were achieved by 21.6 degrees on the average postoperatively. There was a mild loss (2 degrees - 4 degrees) of kyphosis correction during follow-up period. Spinal solid fusion at the interface between the graft and adjacent vertebral bodies was shown radiologically in 3.8 months on the average. CONCLUSION: One-stage surgical management has more advantages in that it can completes all the aspects of surgical treatment for spinal tuberculosis. Anterior or posterior instrumentation with titanium-alloy or stainless steel spinal implants is safe, The selection of one-stage surgical procedure should be planed individually.

Adolescent↗
PubMed1986

False-normal bone imaging in spinal tuberculosis.

Tc-99m MDP bone imaging in spinal tuberculosis usually shows increased radioactivity at the sites of involvement. Uncommonly, the bone scan can be normal if the infection is low grade, indolent, or severely destructive. Two cases of spinal tuberculosis with normal bone imaging are reported. A normal bone image does not exclude tuberculous spondylitis. If there is clinical suspicion of this disease, further investigations, including tissue specimens, should be obtained.

Aged↗
PubMed2006

Current difficulties in the diagnosis and management of spinal tuberculosis.

BACKGROUND: The diagnosis of spinal tuberculosis (ST) is difficult and it commonly presents at an advanced stage. The management and follow up is complicated by a lack of guidance on the appropriate use and interpretation of spinal magnetic resonance studies (MR). AIMS: A retrospective study was performed at a UK centre to identify the demographic and presenting features of a spinal TB population, their response to treatment, and the value of follow up MR studies. PATIENTS AND RESULTS: Twenty one patients were identified with mean symptom duration of 11 (1.5-36) months having been assessed by a health practitioner on 3.2 (0-10) occasions before referral for investigation for ST. Twenty were born outside the UK. Their mean duration of residence in the UK was 6.67 (0.75-20) years, and six (32%) were resident for more than 10 years. Most (85.7%) did not have a medical history and one was HIV positive. Back pain, neurological, and constitutional symptoms were found in 100%, 29%, and 38% respectively. Musculoskeletal and neurological signs were found in 29% and 19% respectively. Spinal MR performed between 6 and 12 months suggests that six months of chemotherapy (for a fully sensitive organism) may not be sufficient to achieve disease resolution. CONCLUSIONS: Awareness of the demographic, clinical, and laboratory features of an ST population may facilitate earlier diagnosis. Guidance is required on the appropriate use and interpretation of MRI in the follow up of these patients.

Adult↗
PubMed2003

One-stage posterior surgery for treatment of advanced spinal tuberculosis.

BACKGROUND: It is not uncommon that some patients in poor general condition and advanced spinal tuberculosis cannot proceed with the staged anterior spinal surgery after posterior instrumentation. We demonstrated a group of patients with advanced spinal tuberculosis that were treated posterior procedure alone. METHODS: From January 1993 to January 2001, 12 patients in our hospital in poor general condition and advanced spinal tuberculosis-marked abscess with angular deformity more than 25 degrees and/or spinal canal compromised more than 30%, were treated in our hospital with posterior instrumentation and chemotherapy only. All patients were immobilized postoperatively with orthosis until solid fusion was noted on bony graft. The chemotherapy persisted for at least 12 months in all patients. RESULTS: Spontaneous bony fusion of vertebrae at 1-year follow-up averaged 75%. Solid union on posterior or posterolateral fusion was about 91.7%. Implant loosening and deep wound infection were noted in 2 of the patients respectively. We assessed the functional results with the postoperative activity condition, symptom relief and medication dependence in the 6th month after the spinal surgery. Seven cases of the 12 patients (58.3%) had good to excellent results in this series. CONCLUSIONS: The one-stage posterior surgery adjunct with chemotherapy is a considerable and alternative treatment for patients with advanced spinal tuberculosis and in poor general condition.

Adult↗
PubMed1999

[Spinal tuberculosis in children: contribution of imaging to diagnostic and therapeutic management].

BACKGROUND: Spinal tuberculosis is an increasingly common condition, particularly in children. CASE REPORT: A 2-year-old boy presented with spinal tuberculosis with psoas abscesses. Radiological imaging played a major role in the diagnostic process. DISCUSSION: In children, spinal tuberculosis is a serious condition due to its rapid spread. Clinical symptoms are often insidious and histological and bacteriological studies may fail to disclose the diagnosis. Radiological investigations are essential in the diagnostic approach.

Child↗
PubMed1984

Atypical spinal tuberculosis.

The familiar picture of spinal tuberculosis is one of destruction of adjacent vertebral bodies and of the intervening disc. There are, however, other patients without these radiographic changes and with no clinical deformity who present with symptoms and signs of compression of the spinal cord or cauda equina. These patients fall into two different groups: those with tuberculosis of the neural arch; and those with extra-osseous extradural tuberculosis. Both may require laminectomy, but whereas the first has bony involvement and a cold abscess, the second has neither.

Adult↗
PubMed2002

Chemotherapeutic treatment for spinal tuberculosis.

AIM: To evaluate whether 6 months of chemotherapy for patients with spinal tuberculosis prevents relapse as effectively as more than 6 months of chemotherapy. METHOD: Literature review. Medline search including references, from January 1978 to November 2000. Inclusion criteria for publications: diagnosis of spinal tuberculosis confirmed bacteriologically and/or histologically, or probable on the basis of clinical and radiological parameters; treatment regimen (whether or not in combination with surgery) included isoniazid (H), rifampicin (R) and pyrazinamide (Z); follow-up period after completion of treatment of 12 months or more. EXCLUSION CRITERIA: patients with relapse who had previously been treated adequately for tuberculosis. OUTCOME PARAMETERS: Relapse rate. RESULTS: Four publications were found with HRZ regimens of 6 months' duration and 10 publications with HRZ regimens of >6 months' duration. A number of patients had received HRE (E = ethambutol) for > or = 9 months. In the results, no distinction was made between treatment groups. HRZ for 6 months led to a relapse rate of 0% (0/56, 95%CI 0.0-6.4); follow-up after surgical intervention ranged from 6 to 108 months. HRZ for > or = 9 months (> or = 119 patients) or HRE for > or = 9 months (< or = 71 patients) led to a relapse rate of 2% (4/218, 95%CI 0.6-5.0); follow-up after surgical intervention was 6-168 months. Despite the small number of studies, 6 months of therapy is probably sufficient for patients with spinal tuberculosis.

Adult↗