Lateral Extracavitary Approach Versus Posterior Extensive Circumferential Decompression in the Treatment of Complicated Thoracic and Lumbar Tuberculous Spondylitis

The aim of this study was to retrospectively evaluate 45 patients operated upon either by posterior extensive circumferential decompression (PECD) or by the lateral extracavitary (LEC) technique and compare the clinical, radiologic, laboratory, and functional outcomes. The debate continues on the be...

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Published in:	Clinical spine surgery Vol. 30; no. 9; pp. E1211 - E1219
Main Authors:	Omran, Khaled, Abdel-Fattah, Ahmed S, Othman, Ahmed M A, Youssef, Ahmed O, Solimen, Amr, ElRefai, Mohamed A, Saleh, Ahmed N, Ali, Mohammed
Format:	Journal Article
Language:	English
Published:	United States 01-11-2017
Subjects:	Adolescent Adult Decompression, Surgical Follow-Up Studies Humans Kyphosis - surgery Lumbar Vertebrae - diagnostic imaging Lumbar Vertebrae - pathology Lumbar Vertebrae - surgery Magnetic Resonance Imaging Middle Aged Postoperative Care Spondylitis - complications Spondylitis - diagnostic imaging Spondylitis - surgery Thoracic Vertebrae - diagnostic imaging Thoracic Vertebrae - pathology Thoracic Vertebrae - surgery Treatment Outcome Tuberculosis, Spinal - complications Tuberculosis, Spinal - diagnostic imaging Tuberculosis, Spinal - surgery Visual Analog Scale Young Adult
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Summary:	The aim of this study was to retrospectively evaluate 45 patients operated upon either by posterior extensive circumferential decompression (PECD) or by the lateral extracavitary (LEC) technique and compare the clinical, radiologic, laboratory, and functional outcomes. The debate continues on the best decompression-fusion technique for treating complicated spinal tuberculosis. In recent times, the advantages of combined surgery have been successfully achieved using the 1-stage salvage technique, with enough accessibility to all 3 spinal columns. From January 2011 to December 2013, 51 patients with complicated spinal tuberculous were surgically treated at our department. After gaining the approval of the local ethics committee, 45 patients and their records were available for evaluation. The patients were divided into 2 groups. Group I included 23 patients treated with PECD and group II included 22 patients treated with LEC. Two authors and an independent observer performed the final clinical assessment by means of clinical examination and by using the Visual Analog Scale and Oswestery Disability Index for determining pain, disability, and quality of life. The radiographs were reviewed independently by 3 authors and a radiologist for fusion, kyphotic angle, and angle loss rate. Neurological assessment using the American Spinal Injury Association motor index was performed by 2 authors and a neurologist independently. The mean follow-up period was 36±5.5 months. In all patients, local symptoms were relieved significantly postoperatively. There were no major complications in this series. Three patients contracted superficial wound infection and 2 developed intercostal neuralgia. Both complications resolved uneventfully and did not influence the outcome. Solid interbody fusion was diagnosed in 43 cases (95.6%). Deformity correction and neurological recovery were significantly improved in both groups (P<0.001). PECD showed better results than LEC. Both procedures attained good results for maintained deformity correction, bony fusion, spinal cord decompression, and neurological improvement in complicated tuberculous spondylitis. However, PECD may be superior to LEC.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2380-0186 2380-0194
DOI:	10.1097/BSD.0000000000000485