00422051

open access

Version of Record

Comparison of Anterior Instrumentation Systems and the Results of Minimum 5 Years Follow - up in the Treatment of Tuberculosis Spondylitis

English (英語)

The Kobe journal of the medical sciences

50(5/6)

167-180

Kobe University School of Medicine

2005-05

2006-07-15

Anterior debridement, strut grafting and instrumentation have an increasingpopularity in the treatment of tuberculosis of spine. Anterior fixation can be doneeither by a plate or a rod system. This study reports on the surgical results of 59 patientswith Pott's disease that had anterior radical debridement and anterior fusion andanterior instrumentation with 5 years follow - up. Average age at the time of operationwas 46.3 ± 13.5 years. Average follow-up was 84.6 ± 11.3 months. Local kyphosis was measuredas the angle between the upper and lower end plates of the collapsed vertebrae preoperatively,postoperatively and at the last follow-up visit. Vertebral collapse, destruction, cold abscess,and canal compromise were assessed in MR images. The indication for surgery was eitherone of the deformity, instability or neurological compromise. Surgical treatmentincluded anterior radical debridement followed by grafting with tricortical auto graftand anterior instrumentation at levels just above and below the diseased segment(s)with either plate (Sofamor-Danek, Z plate, Group A) or rod (Sofamor-Danek, CDH,Group B) systems. There were 23 patients in group A and 36 patients in group B. Allpatients had similar anti tuberculosis chemotherapy. Patients had similar rehabilitationprogram after the surgery. The deformity in the sagittal and the coronal plane wasmeasured and presence of significant consolidation, along with the absence of implantfailure or correction loss was considered as signs of fusion. The two groups were similaraccording to age (46.9±14.2 vs. 45.8±13.1), gender, average number of involved levels(1.8±0.5 vs. 1.6± 0.5), location of involved levels, severity of deformity (21.5°± 9.9° vs.24.8°± 11.9°) and type of autografts (p>0.05 for all parameters). 39.1 % of patients ingroup A and 41.6 % of patients in group B had neurological compromise withimprovement in majority at the end of follow-up. Deformities were corrected to5.2°±5.7° in group A and 6.1°±6.8° in group B with no significant difference. At the timeof latest follow-up there were 1.7°±2.0° correction loss in group A and 1.4°±1.9° ingroup B with no significant difference in between two groups (p>0.05). Overall, it wasobserved that, the addition of anterior instrumentation increased the rate of correction of thekyphotic deformity (78.5 ± 20.5 %), and was effective in maintaining it with an average

and anterior instrumentation

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