The Extended Posterior Circumferential Decompression Technique in the Management of Tubercular Spondylitis with and without Paraplegia

다국어 초록 (Multilingual Abstract)

Study Design: Retrospective clinical series.
Purpose: To study the clinical, functional and radiological results of patients with tuberculous spondylitis with and without paraplegia, treated surgically using the “Extended Posterior Circumferential Decompression (EPCD)” technique.
Overview of Literature: With the increasing possibility of addressing all three columns by a single approach, posterior and posterolateral approaches are gaining acceptance. A single exposure for cases with neurological deficit and kyphotic deformity requiring circumferential decompression, anterior column reconstruction and posterior instrumentation is helpful.
Methods: Forty-one patients with dorsal/dorsolumbar/lumbar tubercular spondylitis who were operated using the EPCD approach between 2006 to 2009 were included. Postoperatively, patients were started on nine-month anti-tuberculous treatment. They were serially followed up to thirty-six months and both clinical measures (including pain, neurological status and ambulatory status) and radiological measures (including kyphotic angle correction, loss of correction and healing status) were used for assessment.
Results: Disease-healing with bony fusion (interbody fusion) was seen in 97.5% of cases. Average deformity (kyphosis) correction was 54.6% in dorsal spine and 207.3% in lumbar spine. Corresponding loss of correction was 3.6 degrees in dorsal spine and 1.9 degrees in the lumbar spine. Neurological recovery in Frankel B and C paraplegia was 85.7% and 62.5%, respectively.
Conclusions: The EPCD approach permits all the advantages of a single or dual session anterior and posterior surgery, with significant benefits in terms of decreased operative time, reduced hospital stay and better kyphotic angle correction.

참고문헌 (Reference)

1 Goldstein C, "When is a spine fused?" 42 : 306-313, 2011

2 Zahradnik V, "Vascular injuries during anterior exposure of the thoracolumbar spine" 27 : 306-313, 2013

3 Mehta JS, "Tuberculosis of the thoracic spine. A classification based on the selection of surgical strategies" 83 : 859-863, 2001

4 Jain AK, "Tuberculosis of the spine: a fresh look at an old disease" 92 : 905-913, 2010

5 Frankel HL, "The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. I" 7 : 179-192, 1969

6 Zaveri G, "The role of posterior surgery in spinal tuberculosis" 23 : 112-119, 2011

7 Talu U, "The role of posterior instrumentation and fusion after anterior radical debridement and fusion in the surgical treatment of spinal tuberculosis: experience of 127 cases" 19 : 554-559, 2006

8 Rajasekaran S, "The problem of deformity in spinal tuberculosis" (398) : 85-92, 2002

9 Konstam PG, "The ambulant treatment of spinal tuberculosis" 50 : 26-38, 1962

10 Laheri VJ, "Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine" 39 : 429-436, 2001

11 Jain AK, "Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach" 90 : 1477-1481, 2008

12 Klockner C, "Sagittal alignment after anterior debridement and fusion with or without additional posterior instrumentation in the treatment of pyogenic and tuberculous spondylodiscitis" 28 : 1036-1042, 2003

13 Sundararaj GD, "Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine" 85 : 100-106, 2003

14 Moon MS, "Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines" 20 : 1910-1916, 1995

15 Ma YZ, "Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults" 36 : 299-305, 2012

16 Li M, "One-stage surgical management for thoracic tuberculosis by anterior debridement, decompression and autogenous rib grafts, and instrumentation" 11 : 726-733, 2011

17 Zhang HQ, "One-stage surgical management for multilevel tuberculous spondylitis of the upper thoracic region by anterior decompression, strut autografting, posterior instrumentation, and fusion" 20 : 263-267, 2007

18 Li C, "Modified single-stage transpedicular decompression, debridement, and posterior instrumentation in treatment of thoracic tuberculosis" 25 : 1294-1297, 2011

19 Dove J, "Internal fixation of the lumbar spine. The Hartshill rectangle" (203) : 135-140, 1986

20 McAfee PC, "Interbody fusion cages in reconstructive operations on the spine" 81 : 859-880, 1999

21 Upadhyay SS, "Duration of antituberculosis chemotherapy in conjunction with radical surgery in the management of spinal tuberculosis" 21 : 1898-1903, 1996

22 Czerwein JK Jr, "Complications of anterior lumbar surgery" 19 : 251-258, 2011

23 Chen WJ, "Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis" (398) : 50-59, 2002

24 Rand C, "Anterior spinal tuberculosis: paraplegia following laminectomy" 71 : 105-109, 1989