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SA Orthopaedic Journal

Print version ISSN 1681-150X

Abstract

RIEMER, Bryan  and  DUNN, Robert. Anterior-only transthoracic surgery for adult spinal tuberculosis. SA orthop. j. [online]. 2011, vol.10, n.3, pp. 43-47. ISSN 1681-150X.

Historically, anterior decompression followed by posterior fusion has been the surgical management of choice in spinal tuberculosis. Due to theatre time being at a premium, we have evolved to anterior only debridement, allograft strut reconstruction and instrumentation for tuberculosis in the adult thoracic spine. The aim of this study was to review the safety and efficacy of this treatment. METHODS: Twentynine adult thoracic tuberculosis patients were identified where anterior-only surgery had been performed. These were all midthoracic TB as circumferential surgery is still favoured in thoraco-lumbar disease. The surgery was performed by a single surgeon at a tertiary hospital. A retrospective review of clinical notes and radiological studies was performed. RESULTS: The average surgical time was 2 hours 15 minutes with a median blood loss of 700 ml. The majority of patients had two vertebral bodies involved and required an average of a four-body fusion. Twenty-eight of the patients presented with altered neurology; three only had sensory changes while 25 presented with paraparesis and an inability to ambulate. Twentythree patients recovered to independent mobility at their latest follow-up appointment. There was an average preoperative kyphosis angle of 33º, which improved immediately post-operatively to 22º, (p = 0.03). The average deformity at latest follow-up was 32º (p = 0.003). Sixteen of 28 patients had documented bony fusion with no evidence of instrumentation failure or loosening in any patients. There were two deaths related to the patients' general poor state of health and co-morbidities. CONCLUSION: Transthoracic anterior-only debridement, allograft strut graft and simple body fixation provides an effective option for the management of adult thoracic tuberculosis. There is a high success rate in achieving return to ambulatory status with few complications. Although loss of early sagittal correction is seen with time, this does not affect neurological outcome. Intra-operative attention to maintaining end-plate integrity is encouraged in an effort to reduce graft subsidence.

Keywords : Spine; tuberculosis; anterior; surgery; adult.

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