During the period from January 1967 to December 1977, 244 cases of tuberculosis of the spine were operated on at the Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea. We followed up 176 cases from 6 months to 10 years and the average period was one year and ten months. (Radical curettage and anterior interbody fusion 129 cases, posterior fusion 20 cases, curettage without bone graft 21 cases, and combined anterior and posterior fusion 6 cases.) The results of those studies are as follows: 1) The incidence of Pott's-parplegia was 25% (61 cases) of the total cases. 2) Almost 41 cases (66%) of the total cases of Pott's parplegia have recovered well enough to return after operation to their previous work. 3) In children (below 15 years of age) 50 cases (87.7%) had satisfactory results with bony fusion and in adults 93 cases (94.9%). 4) In children 44 cases (77%) had healing of radiological activity after operation and in adults 104 cases (87%). 5) The younger the spine, the lower the fusion rate. Combined anterior and posterior fusion is the choice of treatment for tuberculosis of the spine in children. 6) Postoperative complications occured in 38 cases (16%) including wound infection, postoperative pneumonia, postoperative pneoumothorax, postoperative atelectasis, paralytic ileus, meningitis, cystitis, and failure in bone graft.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Infant ; Korea ; Male ; Middle Age ; Spinal Fusion ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Spinal/complications ; Tuberculosis, Spinal/epidemiology ; Tuberculosis, Spinal/surgery*

A total 12 cases of tuberculous spondylitis of thoracic spine had been treated by anterior decompression and interbody fusion through extrapleural approach from March, 1979 to June, 1980. In this study, six impending or complete paraplegics were included. Prognosis of paraplegia depends on its grade, duration and local pathology. Extrapleural approach seems to offer the following advantages over all the other ones; lesser risk, no Iimitation of surgical fleid, less chance of contaminating pleural cavity, less postoperative complications, especially indicated for the elderly paraplegics of Incomplete or complete type and less cumbersome Immediate postoperative care.
Aged ; Decompression ; Humans ; Paraplegia ; Pathology ; Pleural Cavity ; Postoperative Care ; Postoperative Complications ; Prognosis ; Spine ; Spondylitis ; Tuberculosis, Spinal

STUDY DESIGN: Medical record-based survey. PURPOSE: To survey the overall incidence of the intra- and postoperative complications and sequelae, and to propose the preventive measures to reduce complications in the spinal tuberculosis surgery. OVERVIEW OF LITERATURE: There is no study focused on the surgery-related complications and sequelae, with some touching lightly on the clinical problems. METHODS: There were 901 patients in this study, including 92 paraplegics. One hundred eighty-six patients had no visible deformity, while those of 715 patients were visible. Six hundred fifty-nine patients had slight to moderate non-rigid kyphosis, and 56 had severe rigid kyphosis. Sixty-seven out of 92 paraplegics had slight to moderate non-rigid kyphosis, and 25 had severe kyphosis. There were 134 cervical and cervicodorsal lesions, 518 thoracic and thoracolumbar lesions, and 249 lumbar and lumbosacral lesions. Seven hundred sixty-four patients had primarily anterior surgeries, and 137 had posterior surgeries. Instrumentation surgery was combined in 174 patients. RESULTS: There were intra- and postoperative complications: direct large vessel and neurological injuries (cord, roots, nerves), late thrombophlebitis, various thoracic cavity problems, esophagus and ureter injuries, peritoneum perforation, ileus, wound infections, stabilization failure, increase of deformity and late adjacent joint and bone problems. Thrombophlebitis and sympatheticolysis symptoms and signs in the lower limbs were the most common complications related with anterior lumbar and lumbosacral surgeries. Kyphosis increased in 31.5% of the non-instrumented anterior surgery cases (42% in children and 21% in adults). CONCLUSIONS: The safe, effective and most familiar surgical procedure should be adopted to minimize complications and sequelae. Cosmetic spinal surgery should be withheld if functional improvement could not be expected.
Child ; Congenital Abnormalities ; Esophagus ; Humans ; Ileus ; Incidence ; Joints ; Kyphosis ; Lower Extremity ; Peritoneum ; Postoperative Complications ; Spine* ; Thoracic Cavity ; Thrombophlebitis ; Tuberculosis* ; Tuberculosis, Spinal ; Ureter ; Wound Infection

STUDY DESIGN: This is a retrospective study. PURPOSE: We wanted to evaluate the treatment outcomes of performing simultaneous anterior and posterior surgery for patients with tuberculous spondylitis and psoas abscess. OVERVIEW OF LITERATURE: Although various treatment options have been used for spinal tuberculosis, there are only a few reports on the treatment of tuberculous spondylitis with psoas abscess. METHODS: Between March 1997 and February 2006, we performed operations on 14 cases of tuberculous spondylitis with psoas abscess. All the cases underwent anterior debridement with an interbody bone graft and posterior fusion with using pedicle screws. RESULTS: Under the Frankel classification, 1 case improved by two grades, 10 cases improved by 1 grade and 3 cases demonstrated no change. The Kirkaldy-Willis functional outcomes were classified as excellent in 10 cases and good in 4. One year after surgery, bony union was confirmed in all 14 cases. The mean kyphotic angle of the spinal lesion was 12.4degrees and the mean lordotic angle at the final follow-up was 6.4degrees. Postoperative complications (superficial wound infections) were encountered in 2 cases. CONCLUSIONS: Our results demonstrate that anterior debridement with interbody bone grafting and posterior instrumented fusion can provide satisfactory results for treating tuberculous spondylitis with psoas abscess in patients with neurological deficits.
Bone Transplantation ; Debridement ; Follow-Up Studies ; Humans ; Postoperative Complications ; Psoas Abscess ; Retrospective Studies ; Spondylitis ; Transplants ; Tuberculosis, Spinal

OBJECTIVETo observe the results of posterior osteotomy and correction in the surgical treatment of old tuberculous kyphosis.

METHODSFrom June 2004 to December 2008, 31 cases of old tuberculous kyphosis with posterior osteotomy and correction technique were treated. There were 12 cases of male and 19 cases of female. The average age was 33.4 years. Pedicle subtraction osteotomy or vertebral column resection were applied in surgery. The kyphosis angle, lumbar lordosis angle and sagittal balance condition of the spine were measured before and after surgery, as well as follow-up. The Frankel grading system for neurological function of lower extremities, the Oswestry disability index (ODI) for life quality, and patient satisfactory index (PSI) for satisfaction of surgery were applied before surgery and at follow-up.

RESULTSThe average kyphosis angle was 94° ± 27°, the average lumbar lordosis angle was 71° ± 20°, and the average sagittal C(7) plumb line was (-15 ± 44) mm away from the balance region before surgery. The average kyphosis angle decreased to 26° ± 11° in one week after surgery, with an improvement rate of 71.4%. The average follow-up time was 22.5 months. The average kyphosis angle was 28° ± 12° at the final follow-up, with an improvement rate of 70.0%. The average lumbar lordosis angle was 46° ± 11°, with an improvement rate of 35.1%. The postoperative kyphosis angle and lumbar lordosis angle were significantly different with that of pre-operation (for kyphosis angle: t = 16.3, P < 0.05; for lumbar lordosis angle: t = 8.1, P < 0.05). The average sagittal C(7) plumb line was (-4 ± 22) mm away from the balance region at the final follow-up, with an improvement rate of 73.4%. The Frankel grading were E in 13 cases, D in 13 cases, and C in 5 cases before surgery, and were E in 20 cases, D in 8 cases, and C in 3 cases at the final follow-up. The average ODI was 13 ± 12 before surgery, and was 7 ± 8 at the final follow-up, with an improvement rate of 45.2%. The PSI results showed a satisfied rate of 90.3%.

CONCLUSIONGood results can be achieved by applying proper posterior osteotomy and correction technique according to the severity of old tuberculous kyphosis.

Adolescent ; Adult ; Female ; Follow-Up Studies ; Humans ; Kyphosis ; etiology ; surgery ; Male ; Middle Aged ; Osteotomy ; methods ; Spinal Fusion ; methods ; Treatment Outcome ; Tuberculosis, Spinal ; complications ; Young Adult

OBJECTIVETo evaluate the clinical effect of one stage anterior and posterior fusion and posterior fixation for the treatment of thoracic and lumbar spinal tuberculosis.

METHODSFrom March 2003 to December 2006, one stage anterior and posterior fusion and posterior fixation were performed to treat 23 patients who suffered thoracic and lumbar spinal tuberculosis. There were 15 males and 8 females with an average of 37.6 years (17-61 years). 4 cases' tuberculose focus were in thoracic vertebra, 8 cases in thoracolumbar, 11 cases in lumbar.

RESULTSThe average follow up period was 28.7 months (9-40 months). The symptoms of all patients had primarily relieved and the patients can ambulate at 2-3 weeks after treatment. At the 6th after operation, the X-ray showed interbody fusion. Frankel grading of 16 patients with incomplete paraplegia were improved averagely 1.62 grades. The major complications including 2 cases of temporary sinus formation, 1 case of fixtor breaking and 1 case of recurring (owing to an inadequate postoperative chemotherapy).

CONCLUSIONOne stage anterior and posterior fusion and posterior fixation can effectually resect focus, rebuild stability of spine, promote interbody fusion and recovery of incomplete paraplegia in treating thoracic and lumbar spinal tuberculosis.

Adolescent ; Adult ; Female ; Fracture Fixation, Internal ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Postoperative Complications ; Spinal Fusion ; Thoracic Vertebrae ; surgery ; Treatment Outcome ; Tuberculosis, Spinal ; surgery ; Young Adult

OBJECTIVETo compare two kinds of method for treating lumbar tuberculosis with psoas abscess, to provide reference for clinical reasonable select of therapy treatment.

METHODSFrom January 2010 to January 2013,42 patients with lumbar tuberculosis combined with psoas abscess with obvious surgical indications were enrolled, including 24 males and 18 females with an average age of (38.5 ± 10.2) years old ranging from 21 to 63 years old. All patients were followed up for 18 to 24 months with an average of 20.9 months. Twenty-two patients underwent posterior vertebral body lesions cleared, bone graft fusion and internal fixation and percutaneous puncture catheter drainage for treatment of psoas major abscess as group A, and twenty patients underwent one-stage extraperitoneal approach to remove abscess, posterior vertebral body lesions cleared, bone graft fusion and internal fixation as group B. The operative time, loss of blood, length of hospital stay, clinical cure rate and other clinical results for the two groups were analyzed and compared.

RESULTSThe loss of blood was (452.3 ± 137.6) ml in group A and (603.5 ± 99.6) ml in group B, there was significant statistical difference (P < 0.05). The time of operation was (193.6 ± 91.2) min in group A and (230.5 ± 56.6) min in group B, there was significant statistical difference (P < 0.05). The time of operation and the loss of blood in group A were obviously less than which in group B. In group A 20 cases were cured and 2 cases relapsed, 19 cases were cured and 1 case relapsed in group B, there was no significant statistical differences between two groups regarding cure rate with chi-square test (χ² = 0.000, P = 1.000). All patients in two groups obtained good clinical curative effect. There were no significant statistical difference between two groups regarding for length of hospital stay with t-test (P > 0.05).

CONCLUSIONLumbar spinal tuberculosis with psoas abscess is not absolute indications for anterior open operation. Compared with the combined anterior and posterior surgical procedure, the percutaneous puncture catheter drainage combined with posterior debridement, interbody fusion and internal fixation can achieve the same clinical effect but less trauma for the patients.

Adult ; Case-Control Studies ; Debridement ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Psoas Abscess ; etiology ; surgery ; Spinal Fusion ; Tuberculosis, Spinal ; complications ; surgery ; Young Adult

Cervical Vertebrae ; surgery ; Fracture Fixation, Internal ; Humans ; Internal Fixators ; Male ; Middle Aged ; Treatment Failure ; Tuberculosis, Spinal ; complications ; surgery ; Uremia ; complications ; surgery

OBJECTIVETo discuss the failure reasons of operation for spinal tuberculosis complicated with paraplegia and methods of the second operation.

METHODSSpinal tuberculosis paraplegic patients (18 males, 14 females) were reviewed retrospectively. They have been treated with failing decompressive surgery from January 2001 to December 2006. Seventeen patients received anterior debridement surgery via transpleural approach while the other 15 patients received posterolateral decompression surgery via costotransverse approach. Twenty-two patients got chemotherapy after the surgery.

RESULTSTwenty-three patients were treated by anterior debridement, decompression and graft placement via transpleural approach (9 received the single-stage posterior instrumentation). Five patients received posterolateral debridement and decompression via extrapleural approach. Two patients, recur focus be eliminated. Two patients were given sinus debridement surgery alone. All patients were given anti-tuberculosis chemotherapy. The paraplegia was recovered completely in 26 patients, and partly in 5 patients.

CONCLUSIONSInadequate treatment results in defeated operative. The proper selection of operative modalities and timing on the basis of systematically anti-tuberculosis chemotherapy remains the best mode of therapy for spinal tuberculosis complicated with paraplegia. And it is also essential to choose a radical debridement surgery to decompress the spinal cord and to reconstruct the stability of spine.

Adolescent ; Adult ; Aged ; Child ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Paraplegia ; complications ; Reoperation ; Retrospective Studies ; Treatment Failure ; Tuberculosis, Spinal ; complications ; drug therapy ; surgery

OBJECTIVETo analyze the causes of perioperative complications of single-stage surgical management for spinal tuberculosis.

METHODSOne hundred and twenty patients with thoracic, lumbar and lumbosacral spinal tuberculosis were treated by single-stage surgical management from January 1997 to January 2006 in our unit, including seventy-five males and forty-five females. The mean age was 34.5 (range 17 to 68) years old. The lesion ranged from T(6) to S(1). The anterior procedures of anterior debridement, interbody fusion and anterior fixation were carried out in sixty-five cases, posterior procedures in twenty-six cases, and combined anterior and posterior procedures in twenty-nine cases, respectively. The complications that occurred during surgical procedure and 1 month after operation were recorded. Underlying causes were analysed.

RESULTSThere were 10 cases (8.3%) were recorded of mild to severe complications during perioperative period in 120 patients. The complications and underlying causes were as follows: (1) A patient died from liver failure and blood coagulation dysfunction after operation due to inappropriate surgical timing (n = 1), in which case the patient with lumbosacral spinal tuberculosis also suffered from alcoholic liver sclerosis and dysfunction. (2) False diabetes insipidus (n = 1) and deep vein thrombosis of lower limbs (n = 1) occurred as result of surgical trauma. (3) Tear of iliac vein (n = 1) occurred with lumbosacral spinal tuberculosis because of unclear anatomical relationships when anterior debridement was performed. Injury of lumbar nerve roots (n = 3) and hemothorax (n = 1) also occurred due to mispractice of surgical procedures. (4) Paralysis intestinal obstruction and hypokalemia (n = 2) occurred after anterior procedures for lumbar spinal tuberculosis as a result of other reasons.

CONCLUSIONSImproper perioperative care will lead to complications of single-stage surgical procedures for spinal tuberculosis. Emphasis should be put on preoperative evaluation, surgical planning, and postoperative caring for prevention of complications.

Adolescent ; Adult ; Aged ; Female ; Humans ; Intraoperative Complications ; etiology ; prevention & control ; Male ; Middle Aged ; Perioperative Care ; adverse effects ; methods ; Postoperative Complications ; etiology ; prevention & control ; Retrospective Studies ; Tuberculosis, Spinal ; surgery