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Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis

STUDY DESIGN: Retrospective cohort. PURPOSE: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments. OVERVIEW OF LITERATURE: T...

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Autores principales: Kunakornsawat, Sombat, Philawuth, Nattaphon, Piyaskulkaew, Chaiwat, Pruttikul, Pritsanai, Pluemvitayaporn, Tinnakorn, Kittithamvongs, Piyabuth
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Society of Spine Surgery 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894970/
https://www.ncbi.nlm.nih.gov/pubmed/31352728
http://dx.doi.org/10.31616/asj.2018.0200
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author Kunakornsawat, Sombat
Philawuth, Nattaphon
Piyaskulkaew, Chaiwat
Pruttikul, Pritsanai
Pluemvitayaporn, Tinnakorn
Kittithamvongs, Piyabuth
author_facet Kunakornsawat, Sombat
Philawuth, Nattaphon
Piyaskulkaew, Chaiwat
Pruttikul, Pritsanai
Pluemvitayaporn, Tinnakorn
Kittithamvongs, Piyabuth
author_sort Kunakornsawat, Sombat
collection PubMed
description STUDY DESIGN: Retrospective cohort. PURPOSE: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments. OVERVIEW OF LITERATURE: The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach. METHODS: The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients. RESULTS: The patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference. CONCLUSIONS: Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions.
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spelling pubmed-68949702019-12-11 Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis Kunakornsawat, Sombat Philawuth, Nattaphon Piyaskulkaew, Chaiwat Pruttikul, Pritsanai Pluemvitayaporn, Tinnakorn Kittithamvongs, Piyabuth Asian Spine J Clinical Study STUDY DESIGN: Retrospective cohort. PURPOSE: To evaluate clinical outcomes, including pain and neurologic status, and to evaluate radiographic outcomes of patients treated with extended posterior decompression, posterior fixation, and fusion in different vertebral segments. OVERVIEW OF LITERATURE: The standard surgical treatment of spinal tuberculosis is radical debridement via anterior approach. However, this approach may lead to several serious complications. Meanwhile, extended posterior approach, the posterior surgical approach, involving the removal of posterior elements, ribs, and pedicles, is an alternative option that can achieve the aims of treatment in this disease and may reduce the serious complications from anterior approach. METHODS: The medical records and imaging of 50 patients admitted with spinal tuberculosis from January 2010 to June 2016 were reviewed. The Visual Analog Scale (VAS), Frankel grading scale, and kyphotic Cobb angle between the pre- and postoperative periods were used to evaluate the patients. RESULTS: The patients had significant improvement of VAS score in all the groups. The T/T–L, L, and L–S group scores improved from 7.2±1.5 to 1.7±1.2 (p<0.01), from 8.1±1.8 to 1.7±1.4 (p<0.01), and from 7.9±2.2 to 1.7±0.8 (p<0.01), respectively, and overall, the patient scores (n=50) improved from 7.8±1.4 to 1.7±1.3 (p<0.01). Ten patients (20%) had Frankel grade E preoperatively, which was improved to 38 patients (76%) postoperatively. A significant improvement of the kyphotic Cobb angle was observed when compared at the preoperative, early postoperative, and final follow-up period in the T/T–L, L, and L–S groups. The loss of correction angle in the LS group was 7.7°±4.3° at the final follow-up compared with the early postoperative correction angle at 9.1°±5.8°, with no statistically significant difference. CONCLUSIONS: Extended posterior decompression, posterior instrumentation, and fusion are effective methods of surgery for treatment of spinal tuberculosis involved in the thoracic, thoracolumbar, lumbar, and lumbosacral regions. Korean Society of Spine Surgery 2019-12 2019-07-30 /pmc/articles/PMC6894970/ /pubmed/31352728 http://dx.doi.org/10.31616/asj.2018.0200 Text en Copyright © 2019 by Korean Society of Spine Surgery This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Clinical Study
Kunakornsawat, Sombat
Philawuth, Nattaphon
Piyaskulkaew, Chaiwat
Pruttikul, Pritsanai
Pluemvitayaporn, Tinnakorn
Kittithamvongs, Piyabuth
Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title_full Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title_fullStr Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title_full_unstemmed Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title_short Extended Posterior Decompression and Instrumented Fusion for Spinal Tuberculosis
title_sort extended posterior decompression and instrumented fusion for spinal tuberculosis
topic Clinical Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6894970/
https://www.ncbi.nlm.nih.gov/pubmed/31352728
http://dx.doi.org/10.31616/asj.2018.0200
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