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

Retrospective Comparative Study.

A comparative analysis was aimed at evaluating the clinical and radiologic outcomes of cases managed with versus without ACR.

Management of spinal tuberculosis (STB) is accomplished with or without anterior column reconstruction (ACR). However, no objective criterion has been defined citing absolute indication.

A retrospective analysis of prospectively collected data of STB was carried out with a minimum follow-up of one year. Along with basic demography, radiologic parameters like vertebral body height loss (VHL), column height loss (CHL), segmental kyphosis (SK), and adjusted kyphosis (AK) were calculated. A ROC curve analysis was done to identify cutoff values, followed by subgroup analysis for each parameter.

In total 103 patients (60 female, 43 male), 55 cases were managed operatively and ACR was done in 39 of those. Change in ODI, VHL, and kyphosis correction were significantly better in ACR ( P <0.01). ROC analysis identified cutoff values for VHL 0.55 (sensitivity 0.87, 1-specificity 0.37), CHL 1.12 (sensitivity 0.76, 1-specificity 0.25), and AK 15° (sensitivity 0.74, 1-specificity 0.43). Subgroup analysis was carried out in operated patients segregated above these cutoff values. Though vertebral height gain was better with ACR, no significant differences across the change in ODI and loss of correction were noted between ACR and N-ACR. However, the instruments to disease vertebrae (I/D) ratio was significantly different across all subgroups ( P <0.05).

A similar functional outcome, kyphosis correction, and mechanical stability (loss of correction) can be achieved without ACR if index screw purchase with increasing the implant density is feasible. In cases where the index screw deems impossible, the objective criteria of VHL>0.55, CHL>1.1, AK>15 degrees should be considered for deciding the need for anterior column reconstruction to achieve better outcomes.

Level III.