Surgical Management for Spinal Tuberculosis: A Review
Journal Title: Journal of Medical Science And clinical Research - Year 2017, Vol 5, Issue 3
Abstract
Spinal tuberculosis (TB) incidence in both developing and developed countries has dramatically increased, owing to the increase of HIV infection and drug resistance [1,2]. Antituberculous chemotherapy is proven to be ineffective in the prevention of paraplegia, kyphosis and instability of vertebrae [3] . Surgical procedures are a supplementary of chemotherapy playing an important role in the treatment of patients with neurological deficit, caseous abscesses or sequestrum formation, unstable spine and kyphotic deformity[4, 5]. Current surgical approaches mainly advocated by the surgeons are anterior approach alone, posterior approach alone and combined approach. To date, consensus as to whether anterior or posterior approach or combined approach should be applied in the treatment of spinal TB is not available in the literature. Based on analysis of many literatures, an anterior radical debridement and strut grafting with instrumentation allow reaching the focal point of the disease directly, effective debridement of the focal point. But, it also has many disadvantages which includes great surgical invasion, crinose complications and comparatively ineffective correction of instability and lordosis. Though a posterior debridement and strut grafting with instrumentation may not fit for the patients with prevertebral or paravertebral huge abscess or large vertebral destruction, it is safer, technically easier, effective kyphosis correction and less potential intra- and post- operative complication which can be associated with the anterior and combined posterior procedures. The combined approach owns both advantages of anterior and posterior surgery suitable for patients with extreme prevertebral or paravertebral huge abscess or large vertebral destruction. But, it is not advisable for every patient, as it has a longer operation time, longer healing duration, and higher incidence of surgical complications. Consequently, the operating management choices for spinal TB should follow to the needs of the individual patient. With the continuous development of posterior techniques, the posterior debridement achieves the role of anterior debridement to a certain extent. Based on analysis of the literatures, posterior debridement and bone grafting fusion with posterior instrumentation mentioned by more and more surgeons and acquired favorable outcomes can be the superior surgical approach to spinal TB at early metaphase
Authors and Affiliations
Dr Ahsan Shaik Mohammed
Keywords
Related Articles
- EP ID EP278859
- DOI -
- Views 52
- Downloads 0
Mycobacterium tuberculosis resistance to Isoniazid and Rifampicin in a HIV- 1 endemic population in western Kenya in 2012-2014
Background: Mono-resistant and multi-drug resistant tuberculosis (MDR-TB) has been enhanced by delays in the identification of resistant strains. However, resistance gene patterns and the extent of monoresistant TB and M...
Hemangiopericytoma in the Retroperitoneal Space: A Case Report
Introduction: A hemangiopericytoma is a rare soft tissue tumor of vascular origin representing 1% of all vascular neoplasms. It is derived from a pericyte of Zimmerman, which is a modified smooth muscle cell that surroun...
Study on Lipid Profile in Gestational Diabetic Patient and Normal Pregnant Women
Background: Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance with onset or first recognition during pregnancy. Exposure of the fetus to maternal hyperglycemia can cause fetal malformati...
The Mixed Epethelial Stromal Tumor in Medullary Sponge Kidney - A Rare Case Report
Mixed epithelial stromal tumor is rare distinctive kidney tumor which has been described over past few years. It is new entity included in WHO 2004 renal tumor classification. Mixed epithelial stromal tumor occurring in...
Study the Effects of Lead on Thyroid Functions in Alexandria Occupationally Exposed Workers
This study aimed to explore the effects of lead on the thyroid function of Alexandria occupationally exposed workers. One hundred male workers occupationally exposed to lead in a factory for bullets and shots were invest...