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Abstract
Study design
Thirty- seven patients with spinal tuberculosis were evaluated according to surgical method.
Objectives
To evaluate the effectiveness of posterior spinal instrumentation in the surgical treatment of patient with tuberculous spondylitis.
Summary of literature reviews
There are many debates about the effectiveness of posterior spinal instrumentation combined with anterior interbody fusion in tuberculous spondylitis.
Materials and Methods
From January 1995 to June 2000, 37 patients were divided into two groups depending on their use of posterior spinal instrumentation. Group I consist of thirteen patients who were treated with conventional anterior corpectomy and anterior interbody fusion using autogenous strut bone graft. Group II was composed of twenty- four patients who were treated with conventional anterior corpectomy and anterior interbody fusion combined with posterior spinal instrumentation. Changes of corrected kyphotic angle and complication were measured using pre-, postoperative and followup radiographs and chart review.
Results
In group I, six cases (46.2%) showed loss of corrected kyphotic angle. Of these six cases, five cases had initial kyphotic angle of more than 20° and three cases had involvement of two or more vertebrae. All six cases had thoracic or thoracolumbar involvement. Comparing two groups, maintaining corrected kyphotic angle and low complication rates were obtained in group II during followup period. The change of deformity as followed. In thoracic area, the mean kyphotic angle of 26.5°was reduced to 18°postoperatively, A t the most recent followup, the mean kyphotic angle was 31.5°in group I, a loss of correction of 13.5°. In group II, the mean kyphotic angle was corrected from 27°to 13.5°after surgery. A t the most recent followup, the mean kyphotic angle was 17.5°, a loss of correction of 4°.
Conclusion
Posterior spinal instrumentation combined with conventional anterior corpectomy and anterior interbody fusion were found to be effective for preventing loss of kyphotic angle and for maintaining stable bone fusion in patients with mean kyphotic angle more than 20 。, or even in case of less than 20。 but with high risk of developing kyphotic changes due to mul-tiple involved vertebrae.
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Figures and Tables%
Fig. 1.
Preoperative, postoperative and follow up radiographs and MRI showing T7~8 tuberculous spondylitis of a 57-year-old male patient. This patient was treated by posterior instrumentation combined with anterior radical excision and anterior interbody fusion. A, B, C. Preoperative AP, Lateral radiographs and MRI. D, E. Last followup radiographs Preoperative kyphotic angle (20°) was maintained until postoperative 22 months. Final kyphotic angle was 5°.
Fig. 2.
Preoperative, postoperative and follow up radiographs showing T9~10 tuberculous spondylitis of a 37-year-old female patient. A. Preoperative AP, Lateral radiographs. B. Postoperative AP, Lateral radiographs. C. Last followup AP, Lateral radiographs. Preoperative kyphotic angle (32°) was corrected to 18°. final kyphotic angle was 39°
Table 1.
Changes of kyphotic angle in T-spine (°)
| preoperative | postoperative | Last F/U | |
|---|---|---|---|
| Group I | 26.5 | 7.4 | 19.6 |
| Group II | 27 | 8 | 12 |
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