Management Guidelines for Anterior Column Reconstruction in Spinal Tuberculosis-A Comparative Outcome Analysis

Area of Science:

• Spine surgery
• Orthopedic surgery
• Spinal tuberculosis management

Background:

• Spinal tuberculosis (STB) management involves decisions regarding anterior column reconstruction (ACR).
• Currently, no definitive criteria exist to mandate ACR in STB cases.
• This study addresses the need for objective guidelines in STB treatment.

Purpose of the Study:

• To compare clinical and radiologic outcomes of STB patients treated with and without ACR.
• To establish objective criteria for deciding the necessity of ACR in STB.
• To evaluate the impact of ACR on functional recovery and spinal stability.

Main Methods:

• Retrospective analysis of prospectively collected STB patient data (minimum one-year follow-up).
• Radiologic parameters assessed: vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), and adjusted kyphosis (AK).
• Receiver Operating Characteristic (ROC) curve analysis to determine cutoff values for VHL, CHL, and AK.

Main Results:

• ACR group showed significantly better improvement in Oswestry Disability Index (ODI), VHL, and kyphosis correction (P <0.01).
• ROC analysis identified cutoff values: VHL >0.55, CHL >1.12, AK >15 degrees.
• No significant differences in ODI change or loss of correction between ACR and non-ACR groups when using these criteria; however, instrument to diseased vertebrae ratio differed significantly (P <0.05).

Conclusions:

• Similar functional outcomes, kyphosis correction, and mechanical stability can be achieved without ACR if adequate screw purchase and implant density are feasible.
• Objective criteria (VHL>0.55, CHL>1.1, AK>15°) should guide the decision for ACR when index screw purchase is not possible.
• These criteria aid in optimizing STB treatment strategies for better patient outcomes.