Comparative study of debridement, fusion and instrumentation via single stage anterior or single stage posterior approach in dorsolumbar spinal tuberculosis
Journal Title: International Journal of Orthopaedics Sciences - Year 2017, Vol 3, Issue 3
Abstract
Background: There is controversy regarding approach for surgical treatment of dorsolumbar spinal tuberculosis. The aim of this study is to make a comparative study on the basis of clinico-serological, radiological, neurological, pain improvement and kyphotic angle correction between anterior and posterior surgery in dorsolumbar spinal tuberculosis. Materials and methods: The study was performed on a cohort comprising of 40 patients treated surgically between Feb'09 to Jan'13. All these patients were analyzed and divided into two groups on the basis of surgical approach. Group I comprised 18 patients who underwent anterior debridement, decompression and instrumentation by either transthoracic transpleural or thoracoabdominal diaphragm cutting or retroperitoneal approach depending upon location of lesions. Group II comprised 22 patients who were operated by posterior transpedicular decompression, debridement and instrumentation with or without anterior interbody cage through midline posterior approach. Various parameters were assessed like surgical time, intra-operative blood loss, improvement in ESR, neurological recovery, correction of kyphosis and loss of correction of kyphosis, VAS pain score, functional outcome by Prolo's scale and fusion according to Bridwell criteria. Results: Mean surgical time was more in Group I than Group II. Average blood loss was less in Group I. Clinico-serological outcome was better in Group I when compared to Group II. Regarding neurological outcome all patients improved at least 1 grade except one patient in Group II who deteriorated from Frankel D to Frankel C. Mean kyphotic angle correction was better in Group II with less loss of correction (LOC). Post-operative pain improvement, functional outcome and fusion based on Bridwell criteria were better in Group II compared to Group I. Conclusion: Single stage posterior approach with transpedicular decompression, debridement, fusion and instrumentation is better than anterior approach owing to its better functional outcome, less morbidity, early mobilization and rehabilitation, better kyphotic correction and better maintenance of correction.
Authors and Affiliations
Nabarun Saha, Kiran Kumar Mukhopadhyay, Anant Kumar Garg, Sanjay Kumar, Partha Sarathi Sarkar
Keywords
Related Articles
- EP ID EP502640
- DOI 10.22271/ortho.2017.v3.i2j.100
- Views 126
- Downloads 0
Management of lower humeral intercondylar fractures in adults with different implants
We reviewed the results of internal fixation with various types of implants in a series of 20 patients (mean age, 33.6 years; range, 21-58 years) with type C intraarticular fractures of the distal humerus after a mean fo...
The results of closed reduction and percutaneous pinning in supracondylar fractures of humerus in children
Introduction: Supracondylar fracture of the humerus is the most common type of elbow injury in children, accounting for 60% of fractures in this area and represent about 3% of all the fractures in children. Treatment of...
A study of functional outcome of distal humerus fractures managed by locking compression plate
Introduction: Fractures of the distal humerus are rare and complex injuries. The complex shape of the elbow joint, the adjacent neurovascular structures, the sparse soft tissue cover combine to make treatment difficult....
Tendinosis as the underlying pathology of osgood-schlatter disease: imaging similarities and treatment implications
Osgood-Schlatter disease is relatively common condition in adolescents. Classically, its pathophysiology is considered to be a traction apophysitis of the proximal tibial tubercle, which is caused from overuse. However,...
Role of Ilizarov ring fixator in definitive management of tibia shaft fractures: A prospective observational study of 50 cases
Introduction: Tibia shaft fractures can be treated with various modes, each having its merits and demerits. The aim of our study was to analyze clinical outcome of Ilizarov technique in patients with tibia shaft fracture...