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Abstract
Objective
To analyze the safety and effectiveness of treatments using metallic implants in the tuberculous spondylitis.
Summary of Literature Review
Residual kyphosis and loss of correction remain the major problems following surgery for tuberculous spondylitis. Several authors have used metallic implants for the prevention of these complications. However, the safety of metallic implants use in tuberculous spine infections are still controversial.
Materials and Methods
Seventeen patients, who underwent surgery, and were stabilized by the use of a metallic implant for tuberculous spondylitis, and followed up for more than 1 year were included in this study. A ll patients were treated with combined anterior fusion (with or without mesh) and/or posterior pedicle screw instrumentation. The patients were followed up with serial plain radiographs, laboratory inflammatory parameters and neurological recovery.
Results
The overall correction of the kyphotic deformity was initially 8.5 degrees, and loss of correction occurred at 5.8 degrees. A lthough some loss of correction occurred, even after the use of a metallic implant, clinically significant kyphotic deformity was effectively prevented. There were no cases of persistent infection or failure to control infection when the metallic implantation was combined with an anterior radical debridement and chemotherapy. The erythrocyte sedimentation rate and C- reactive pro-tein were eventually normalized in all patients. The preoperative neurological deficits were: incomplete paralysis in 9 cases and radiculopathy in 4. A t the final follow- up, 11cases had completely recovered, partial residual neurological deficits remaining in 2.
REFERENCES
1). Bailey HL., Gabriel M., Hodgson AR., Shin JS. Tuberculosis of the spine in children: Operative findings results in one hundred consecutive patients treated by removal of the lesion and anterior grafting. J Bone Joint Surg. 54-A:1633–1657. 1972.
2). Chen WJ., Chen CH., Shih CH. Surgical treatment of tuberculous spondylitis. Acta Orthop Scand,. 66(2):137–142. 1995.
3). Chen WJ., Wu CC., Jung CH., Chen LH., Niu CC., Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop,. 398:50–59. 2002.
4). Guven O., Kumano K., Yalcin S., Karahan M., Tsuji S. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculo -sis. Spine,. 19:1039–1043. 1994.
5). Hodgson AR., Stock FE. Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg,. 42-A:295–310. 1960.
6). Kemp HBS., Jackson JW., Jeremiah JD., Cook J. Anterior fusion of the spine for infective lesions in adults. J Bone Joint Surg,. 55-B:715–734. 1973.
7). Kim KS., Ko SH., Youm KS., Choi CH., Yang JH. Anterior spinal instrumentation in treatment of spinal tuberculosis. J Kor Orthop Assoc,. 33:1560–1568. 1998.
8). Kim BJ., Ko HS., Lim Y., Seo JK., Choi JY., Suh JS. Surgical treatment of paraplegia in spinal tuberculosis. J Kor Orthop Assoc,. 28:1595–1602. 1993.
9). Kim BJ., Ko HS., Lim Y., Seo JG., Zoo SK., Jeon TH. The clinical study of the tuberculous spondylitis. J Kor Orthop Assoc,. 28:2221–2232. 1993.
10). Lee EY., Hahn MS. A study of influences of the qnte -rior intervertebral fusion upon the correctability of kypho -sis in tuberculous spondylitiss. J Kor Orthop Assoc,. 3:31–40. 1968.
11). Medical Research Council Working Party on Tuberculosis of the Spine. A 5-year assessment of controlled trials of in-patients & out-patients treatment & of plaster of Paris jacket for tuberculosis of the spine in children on standard chemotheraphy: Studies in Masan & Pusan, Korea. J Bone Joint Surg. 58-B:399–414. 1976.
12). Moon MS., Woo YK., Lee KS., Ha KY., Kim SS., Sun DH. Posterior instrumentation and anterior interbody fusion for tuberculous kyphosis of dorsal and lumbar spines. Spine,. 20:1910–1916. 1995.
13). Moon MS., Woo YK., Ok IY., Lee KS., Kang YK., Ha KY., Kim SS. Posterior instrumentation for treatment of active dorsolumbar tuberculosis with kyphosis. J Kor Orthop Assoc,. 24:660–665. 1989.
14). Oga M., Arizono T., Takasita M., Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Spine,. 18:1890–1894. 1993.
15). Rajasekaran S., Shanmugasundaram TK. Prediction of the angle of Gibbus deformity in tuberculosis of the spine. J Bone Joint Surg,. 69-A:503–509. 1987.
16). Rajasekaran S., Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg,. 71-A:1314–1323. 1989.
17). Rezai AR., Lee M., Cooper PR., Errico TJ., Koslow M. Modern management of spinal tuberculosis. Neuro -surg,. 36:87–98. 1995.
18). Safran O., Rand N., Kaplan L., Sagiv S., Floman Y. Sequential or simultaneous, same-day anterior decom -pression and posterior stabilization in the management of vertebral osteomyelitis of the lumbar spine. Spine,. 23:1885–1890. 1998.
19). Yilmaz, Cengiz, Selek, Hakan Y, Gurkan, Ilksen, Erdemli, Bulent, Korkusuz and Zeki. Anterior instru -mentation for the treatment of spinal tuberculosis. J Bone Joint Surg,. 81-A:1261–1267. 1999.
Fig. 1.
A 31-year-old woman sustained spinal tuberculous spondylitis of thoracic spine and was treated with the combined anterior and posterior techinque. (A) Preoperative anteroposterior thoracolumbar spine radiograph shows asymmertrical collapsing of T8 vertebral body and paraspinal soft tissue bulging. On the lateral view, destruction of T8 vertebral body and focal kyphotic angulation was noted. (B) Magnetic resonance images showed extent of the lesion more clearly. Affected segment ranged from T6 to T9. Compression of spinal cord by an epidural mass was also evident. (C)(D) Radiographs obtained at postoperative 1-year follow-up shows solid fusion with pedicle screw instrumentation. Anterior fusion with iliac bone graft was per-formed from T6 to T9 and pedicle screws were not inserted to the affected vertebra.
Fig. 2.
A 28-year-old woman who had tuberculous spondylitis at thoracolujmbar junction was treated with the combined anterior tita-nium mesh and posteior pedicle screw techinque. (A) (B) Preoperative radiographs show destruction of T12 vertebral body and obliteration of T12-L1 intervertebral disc space. (C)(D) Radiographs obtained at postoperative 2-year shows stable con-struct and solid fusion.
Table 1.
Patients profile
Table 2.
Changes of kyphosis angle(°)
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