Comparison of Two Surgeries in Active Thoracolumbar Tuberculous Spondylitis: One Stage Anterior Debridement with Anterior Instrumentation and Two Stage Operation of Anterior Debridement and Posterior Instrumentation

Park, Weon Wook; Ahn, Seong Jun; Lee, Jung Sub; Kim, Tae Hyung

doi:10.4184/jkss.2003.10.2.146

J Korean Soc Spine Surg. 2003 Jun;10(2):146-153. Korean.
Published online Jun 30, 2003.
https://doi.org/10.4184/jkss.2003.10.2.146

Original Article

Comparison of Two Surgeries in Active Thoracolumbar Tuberculous Spondylitis: One Stage Anterior Debridement with Anterior Instrumentation and Two Stage Operation of Anterior Debridement and Posterior Instrumentation

Weon Wook Park, M.D., Seong Jun Ahn, M.D.,^§ Jung Sub Lee, M.D.,^† and Tae Hyung Kim, M.D.^*

Author information

Author notes

Copyright and License

- Spine Center, Busan Centum Hospital, Pusan, Korea.
- ^§Department of Orthopaedic Surgery, Dae Dong Hospital, Pusan, Korea.
- ^†Department of Orthopaedic Surgery, Pusan National University Hospital, Pusan, Korea.
- ^*Department of Orthopedic Surgery, Maryknoll Hospital, Pusan, Korea.
Address reprint requests to Seong Jun Ahn, M.D. Department of Orthopaedic Surgery, Dae Dong Hospital, #530-1 Meng Lun-1 dong, Dong Rae-gu, Pusan, 607-712, Korea. Tel: 82-51-554-1233, Fax: 82-51-553-7575, Email: ahnsjosdept@lycos.co.kr

Abstract

Study Design

Thirty-eight patients with thoracolumbar spinal tuberculosis were evaluated according to the surgical treatment method, either a one or two stage anterior debridement, with anterior or posterior instrumentation, respectively.

Purpose

The aim of this study was to compare the effects of the one stage anterior debridement, with anterior instrumentation, to the two stage anterior debridement, with posterior instrumentation

Materials and Methods

Thirty-eight patients, with tuberculous spine, were divided into two groups depending on the surgical method. One group consisted of 21 patients treated with anterior debridement combined with anterior instrumentation, and the other group consisted of 17 patients treated by a two stage operation of anterior debridement combined with posterior instrumentation. The clinical outcomes were evaluated from the hematological laboratory findings, bone union in radiographs, change of kyphotic angle, duration of hospital stay and the medical cost during hospitalization.

Results

There were no recurrences of infection in either group and bone union was obtained within 6 months of the operation for all cases in both groups. The preoperative, postoperative and final follow-up kyphotic angle in the two groups were 18/20, 7/9 and 10/11 degrees, respectively. There was no significant difference in the decrease of the kyphotic angle between the two groups (p>0.05). However, group I was superior to group II in relation to the duration of hospital stay and the medical cost.

Conclusion

We concluded that the one stage operation was the better of the operative methods for the treatment of active tuberculous spondylitis in a thoracolumbar spine.

Keywords

Tuberculous spondylitis; anterior instrumentation; Posterior instrumentation

Figures

Fig. 1
A. Preoperative radiograph of a 55-year-old woman showed L3-4 joint space narrowing and destruction of cartilagenous end plate

B & C. Preoperative T2-weighted coronal and sagittal MR image showed L3-4 involvement and both paraspinal psoas abscess.

D. Immediate postoperative radiograph after L3-4 anterior decompression and strut bone graft with anterior instrumentation.

E & F. At postoperative 13 months, plain radiograph and T2-weighted sagittal MR image showed bony union with satisfactory maintenance of corrective kyphotic angle and didn't show any recurrence of infection.

Click for larger image

Fig. 2
A & B. Preoperative radiograph and T1-weighted sagittal MR image of 55-year-old woman showed T6-7 tuberculous with extended inflammatory discharge into spinal canal.

C. Postoperative radiograph after two stage operation-posterior instrumentation following anterior decompression of involved body and anterior interbody fusion.

D. At postoperative 12 months, T1-weighted sagittal MR image shows no recurrence of tuberculosis infection.

Click for larger image

Tables

Table 1
Changes of kyphotic angle

Click for larger image

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