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Anterior and Posterior Instrumentation with Different Debridement and Grafting Procedures for Multi-Level Contiguous
Xu Cui1, Li-Tao Li1, Yuan-Zheng Ma1
1Department of Orthopaedics, The 309th Hospital of the PLA, Beijing, China.
Orthopaedic Surgery
|December 30, 2016
Summary
Posterior spinal instrumentation effectively corrects kyphosis in thoracic spinal tuberculosis. However, anterior instrumentation may be preferred to reduce the risk of postoperative sinus formation, particularly after single-stage procedures.
Area of Science:
- Spine surgery
- Orthopedics
- Infectious disease management
Background:
- Multi-level contiguous thoracic spinal tuberculosis presents significant challenges in surgical management.
- Effective instrumentation and fusion techniques are crucial for correcting deformity and achieving solid fusion.
Purpose of the Study:
- To compare the clinical outcomes of anterior versus posterior instrumentation for multi-level contiguous thoracic spinal tuberculosis.
- To evaluate different debridement and graft fusion methods in conjunction with spinal instrumentation.
Main Methods:
- Retrospective analysis of 81 patients with thoracic spinal tuberculosis treated between 2002 and 2012.
- Patients were divided into anterior instrumentation (transthoracic debridement) and posterior instrumentation (trans-costotransverse decompression or combined anterior/posterior approach) groups.
- Clinical outcomes including kyphotic angle correction, fusion time, neurologic improvement, and complications were assessed over an average follow-up of 37 months.
Main Results:
- Both anterior and posterior instrumentation groups showed significant correction of kyphotic deformities and improvement in neurologic deficits.
- Posterior instrumentation procedures were associated with longer operative times and greater blood loss compared to anterior approaches.
- Radiographic fusion was achieved at similar intervals in both groups, with a low rate of postoperative relapses.
Conclusions:
- Posterior instrumentation demonstrated superior effectiveness in correcting and maintaining kyphosis correction compared to anterior instrumentation.
- Anterior instrumentation may be associated with a lower incidence of postoperative sinus formation, especially following single-stage posterior procedures.
