Pott's disease surgery: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pott's disease}} | {{Pott's disease}} | ||
{{CMG}} | {{CMG}} {{AE}} {{AKI}} | ||
==Overview== | ==Overview== | ||
Surgery is not the primary treatment for spinal tuberculosis. It is preferred in patients unresponsive to medical therapy and with worsening neurological function. Surgical debridement with cord decompression is performed in such patients. | |||
==Surgery== | ==Surgery== | ||
===Indications for Surgery=== | ===Indications for Surgery=== | ||
The following are the indications for surgery in patients with [[Pott's disease]]:<ref name="pmid28063678">{{cite journal| author=Wang YX, Zhang HQ, Li M, Tang MX, Guo CF, Deng A et al.| title=Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only. | journal=Injury | year= 2017 | volume= 48 | issue= 2 | pages= 378-383 | pmid=28063678 | doi=10.1016/j.injury.2016.12.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28063678 }} </ref><ref name="pmid28056436">{{cite journal| author=Liu JM, Zhou Y, Peng AF, Chen XY, Chen WZ, Long XH et al.| title=One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft. | journal=Clin Neurol Neurosurg | year= 2017 | volume= 153 | issue= | pages= 67-72 | pmid=28056436 | doi=10.1016/j.clineuro.2016.12.013 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28056436 }} </ref><ref name="pmid27990623">{{cite journal| author=Peng L, Hai N| title=The effect of time-to-surgery on outcome in patients with neurological deficits caused by spinal tuberculosis. | journal=Turk Neurosurg | year= 2016 | volume= | issue= | pages= | pmid=27990623 | doi=10.5137/1019-5149.JTN.18736-16.1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27990623 }} </ref><ref name="pmid26715725">{{cite journal| author=Panchmatia JR, Lenke LG, Molloy S, Cheung KM, Kebaish KM| title=Review article: Surgical approaches for correction of post-tubercular kyphosis. | journal=J Orthop Surg (Hong Kong) | year= 2015 | volume= 23 | issue= 3 | pages= 391-4 | pmid=26715725 | doi=10.1177/230949901502300328 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26715725 }} </ref> | |||
*Neurological deficits | *Neurological deficits | ||
*Potential mechanical instability | *Potential [[mechanical instability]] | ||
*Kyphosis leading to sagittal imbalance or severe kyphosis | *[[Kyphosis]] leading to sagittal imbalance or severe [[kyphosis ]] ≥60° | ||
*Large thoracic spine abscess casing esophageal obstruction or cervical abscess causing | *Large [[thoracic spine]] [[abscess]] casing [[esophageal obstruction]] or [[cervical]] [[abscess]] causing [[difficulty in breathing]] | ||
*Abscess increasing in size even after 3 to 6 months of standard medical therapy | *[[Abscess]] increasing in size even after 3 to 6 months of standard medical therapy | ||
*Worsening neurological function during the period of medical therapy | *Worsening [[neurological function]] during the period of medical therapy | ||
*Children | *Children ≤7 years of age, with three or more affected [[vertebral bodies]] | ||
===Surgical Options=== | ===Surgical Options=== | ||
*Surgical therapy for spinal tuberculosis is by decompression of the cord with debridement of the infected tissue via the anterior or anterolateral approach. | *Surgical therapy for [[Pott's disease|spinal tuberculosis]] is by [[decompression]] of the cord with [[debridement]] of the infected tissue via the anterior or anterolateral approach.<ref name="pmid28083459">{{cite journal| author=Golwala P, Kapoor C, Shah M, Merh A, Kansagra A| title=A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique. | journal=Cureus | year= 2016 | volume= 8 | issue= 12 | pages= e915 | pmid=28083459 | doi=10.7759/cureus.915 | pmc=5218885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28083459 }} </ref> | ||
*Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord. | *Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.<ref name="pmid28265884">{{cite journal| author=Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z et al.| title=Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis. | journal=Clin Orthop Relat Res | year= 2017 | volume= | issue= | pages= | pmid=28265884 | doi=10.1007/s11999-017-5306-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28265884 }} </ref><ref name="pmid28169940">{{cite journal| author=D'souza AR, Mohapatra B, Bansal ML, Das K| title=Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation. | journal=Clin Spine Surg | year= 2017 | volume= | issue= | pages= | pmid=28169940 | doi=10.1097/BSD.0000000000000498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28169940 }} </ref><ref name="pmid27792109">{{cite journal| author=Wang LJ, Zhang HQ, Tang MX, Gao QL, Zhou ZH, Yin XH| title=Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow-Up. | journal=Spine (Phila Pa 1976) | year= 2016 | volume= | issue= | pages= | pmid=27792109 | doi=10.1097/BRS.0000000000001955 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27792109 }} </ref> | ||
*Laminectomy for decompression is contraindicated in cases with anterior spinal tuberculosis, as it increases the unstability of the spine. | *[[Laminectomy]] for decompression is contraindicated in cases with anterior [[Pott's disease|spinal tuberculosis]], as it increases the unstability of the [[spine]].<ref name="pmid28112788">{{cite journal| author=Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F et al.| title=Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy. | journal=Orthopedics | year= 2017 | volume= | issue= | pages= 1-7 | pmid=28112788 | doi=10.3928/01477447-20170117-02 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28112788 }} </ref><ref name="pmid27683681">{{cite journal| author=Alam MS, Phan K, Karim R, Jonayed SA, Munir HK, Chakraborty S et al.| title=Surgery for spinal tuberculosis: a multi-center experience of 582 cases. | journal=J Spine Surg | year= 2015 | volume= 1 | issue= 1 | pages= 65-71 | pmid=27683681 | doi=10.3978/j.issn.2414-469X.2015.07.03 | pmc=5039863 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27683681 }} </ref> | ||
==References== | ==References== | ||
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[[Category:Vertebral column disorders]] | [[Category:Vertebral column disorders]] | ||
[[Category:Tuberculosis]] | [[Category:Tuberculosis]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Latest revision as of 18:47, 18 September 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Surgery is not the primary treatment for spinal tuberculosis. It is preferred in patients unresponsive to medical therapy and with worsening neurological function. Surgical debridement with cord decompression is performed in such patients.
Surgery
Indications for Surgery
The following are the indications for surgery in patients with Pott's disease:[1][2][3][4]
- Neurological deficits
- Potential mechanical instability
- Kyphosis leading to sagittal imbalance or severe kyphosis ≥60°
- Large thoracic spine abscess casing esophageal obstruction or cervical abscess causing difficulty in breathing
- Abscess increasing in size even after 3 to 6 months of standard medical therapy
- Worsening neurological function during the period of medical therapy
- Children ≤7 years of age, with three or more affected vertebral bodies
Surgical Options
- Surgical therapy for spinal tuberculosis is by decompression of the cord with debridement of the infected tissue via the anterior or anterolateral approach.[5]
- Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.[6][7][8]
- Laminectomy for decompression is contraindicated in cases with anterior spinal tuberculosis, as it increases the unstability of the spine.[9][10]
References
- ↑ Wang YX, Zhang HQ, Li M, Tang MX, Guo CF, Deng A; et al. (2017). "Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only". Injury. 48 (2): 378–383. doi:10.1016/j.injury.2016.12.025. PMID 28063678.
- ↑ Liu JM, Zhou Y, Peng AF, Chen XY, Chen WZ, Long XH; et al. (2017). "One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft". Clin Neurol Neurosurg. 153: 67–72. doi:10.1016/j.clineuro.2016.12.013. PMID 28056436.
- ↑ Peng L, Hai N (2016). "The effect of time-to-surgery on outcome in patients with neurological deficits caused by spinal tuberculosis". Turk Neurosurg. doi:10.5137/1019-5149.JTN.18736-16.1. PMID 27990623.
- ↑ Panchmatia JR, Lenke LG, Molloy S, Cheung KM, Kebaish KM (2015). "Review article: Surgical approaches for correction of post-tubercular kyphosis". J Orthop Surg (Hong Kong). 23 (3): 391–4. doi:10.1177/230949901502300328. PMID 26715725.
- ↑ Golwala P, Kapoor C, Shah M, Merh A, Kansagra A (2016). "A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique". Cureus. 8 (12): e915. doi:10.7759/cureus.915. PMC 5218885. PMID 28083459.
- ↑ Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z; et al. (2017). "Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis". Clin Orthop Relat Res. doi:10.1007/s11999-017-5306-9. PMID 28265884.
- ↑ D'souza AR, Mohapatra B, Bansal ML, Das K (2017). "Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation". Clin Spine Surg. doi:10.1097/BSD.0000000000000498. PMID 28169940.
- ↑ Wang LJ, Zhang HQ, Tang MX, Gao QL, Zhou ZH, Yin XH (2016). "Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow-Up". Spine (Phila Pa 1976). doi:10.1097/BRS.0000000000001955. PMID 27792109.
- ↑ Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F; et al. (2017). "Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy". Orthopedics: 1–7. doi:10.3928/01477447-20170117-02. PMID 28112788.
- ↑ Alam MS, Phan K, Karim R, Jonayed SA, Munir HK, Chakraborty S; et al. (2015). "Surgery for spinal tuberculosis: a multi-center experience of 582 cases". J Spine Surg. 1 (1): 65–71. doi:10.3978/j.issn.2414-469X.2015.07.03. PMC 5039863. PMID 27683681.