Surgical treatment of acute TB spondylitis: indications and outcomes

Introduction: Spinal tuberculosis represents a challenging disease to treat, not because of the technical expertise or the time required to cure it, but more so because of the decisions involved to treat it. The Medical Research Council (MRC) Working Party on Tuberculosis of the Spine designed trials to help address several questions. Methods: A comprehensive literature search was performed using PubMed Medline, including English articles from 1934 to 1012, which pertain to spinal tuberculosis, with special effort in tracing the 13 MRC reports. The primary focus was on disease eradication, fusion rate, and a secondary focus on both short and long-term results in terms of disease recurrence and alignment. Additional searches were made on the use of spinal implants for infection cases. Results: After reviewing MRC and non-MRC reports, it was evident that the "Hong Kong operation", which involved radical debridement and strut grafting the lesion, produced better short-, medium- and long-term results in such aspects as fusion rate, spinal deformity and relapse of abscess/sinus. Subsequent work by others demonstrated the importance of prevention of progressive kyphosis, therefore the need to identify risk factors for these and pre-emptive measures such as kyphosis correction, careful graft selection, and instrumentation. Conclusion: Improvement in quality of life is also accompanied by higher patient expectations. Though developing nations may lack the resources now, eventually patients will demand better functional and cosmetic results after being afflicted by this disfiguring and potentially disabling disease, and the "Hong Kong operation" represented the best outcome, provided resources were available. © 2012 The Author(s).published_or_final_versio

Tuberculosis of Spine: Current Views in Diagnosis and Management

Tuberculosis is the chronic consumptive disease and currently the world's leading cause of death. Tuberculous spondylitis is a less common yet the most dangerous form of skeletal tuberculosis. The recent re-emergence of Mycobacterium tuberculosis (M. tuberculosis) hints at a possible resurgence of tuberculosis in the coming years. This article discusses the clinical manifestations, diagnosis and treatment of tuberculous spondylitis, and updates material that the author has previously published on the subject. Treatment should be individualized according to different indications which is essential to recovery. A treatment model is suggested on the basis of the author's vast personal experiences

2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adultsa

These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical interventio

Improvement of life after PVCR in complete paraplegic patients with posttraumatic severe kyphosis

AIM: To determine the effect of posterior vertebral column resection (PVCR) in patients with paraplegia by using the American Spinal Injury Association (ASIA) score and Scoliosis Research Society (SRS)-22 questionnaire. MATERIAL and METHODS: Twelve patients with posttraumatic paraplegia and severe angular kyphosis (>60°) had undergone PVCR between 6-24 months after the trauma for severe pain, persistent vertebral instability and difficulty in adherence to rehabilitation. ASIA scores and SRS-22 questionnaire results obtained in the preoperative and postoperative periods, and the last control were statistically compared to assess the presence of any change.RESULTS: The average age of twelve patients included in this study was 35.6 ± 10.2 (21-51) years. Female/male ratio was 2/10 (20.0%). The mean follow-up duration was 50.3 ± 17.6 (24-86) months. None of the patients had additional changes in neuromonitoring records during surgery. The mean preoperative kyphotic angle of the patients was 66.58° ± 7.1° (60°-82°) which decreased to 7.0° ± 5.4° in the postoperative period (p0.05).CONCLUSION: In the light of these data, it can be stated that PVCR is a safe and reliable procedure in paraplegic patients with rigid posttraumatic kyphosis and increases patient satisfaction

Vertebral tuberculosis : a clinical study

(1) Tuberculosis of the spinal column is local evidence of pre- existing general infection. The influence of this conception on treatment is emphasised.The mode of infection is discussed and the haematogenous route is favoured, but it is possible that the lymphatic route may also play a part.Attention is drawn to recent researches into the detailed anatomy of the intervertebral disc. In view of these it is probable that in some cases the primary infection is in the disc.(2) Attention is drawn to the fact that a large percentage of cases of spinal caries under the age of ten years is BOVINE in type, and the bearing of this on the preventive side of treatment is emphasised. It is insisted that a milk supply free from the infecting bacillus is essential.(3) A case is described of the rare condition of tuberculosis of the SPINE of a vertebra.(4) Recent investigations show that a small percentage of abscesses are sterile, due to the fact that the contained Bacilli are "dead". As a rule these do not refill after aspiration.(5) Modern opinion inclines to the belief that a causal relationship between trauma and osseous tuberculosis is extraordinarily rare.(6) It is emphasised that important points in the taking of radiograms are, (a) that the tube must be focussed directly over the affected disc, and (b) that a low penetration, (45 to 55 Kv.) should be used in children to obtain clear details of bone structure. Attention is drawn to the use of lipiodol in tracking sinuses and illustrative radiograms are given.(7) A short description is given of Schmorl's researches on the anatomy of the intervertebral discs showing that spondylitis deformans juvenilis is due to prolapse of the nucleus pulposus rather than to abnormalities in growth of the so- called epiphyses.(8) A description is given of a rare form of osteochondritis vertebralis at first treated as a case of Pott's disease.(9) Pott's disease needs longer and more intensive treatment than is commonly thought. A long period of recumbency is necessary, and institutional treatment is considered essential.(10) Details of the treatment of spinal tuberculosis as carried out in Saint Andrew's Home, Millport, are given.(11) The advantages and disadvantages of nursing in the ventral and dorsal positions are discussed, and the technique followed in Millport is given in detail.(12) The making of plaster half-shells and celluloid. corsets is described.(13) The dangers of mixed infection after sinus formation are emphasised and the importance of dealing with the psoas abscess before it enters the thigh is stressed.(14) The operative treatment of Pott's disease is considered. The conclusion is reached that it is practically never indicated in children, whilst in adults, it is only indicated very exceptionally. It must not be employed with a view to shortening the period of recumbency.(15) A detailed description is given of cases personally studied, representative of the different sites affected and the different complications met with, in the treatment of Pott's disease

A Study on Anterior Decompression and Stabilisation of Dorsolumbar Spine Burst Fractures and Caries Spine

INTRODUCTION: Spine is one of the intriguing regions in Orthopeadics where treatment for its pathology has drawn much controversy. Before the dawn of 20th century spine injuries were treated non-operatively. Later Harrington revolutionized spine care and rehabilitation with introduction of posterior instrumentation. Since then surgical techniques and instruments have proliferated to improve anatomical reduction and alignment of spinal column. But neurological recovery remained mostly unchanged over the results of non operative treatment. However root function and spinal cord function , in selected patients can be improved with appropriate surgery. Dorsolumbar region constitutes the second most common site for spine fractures and burst fractures constitute 60% of dorsolumbar fractures. Though the treatment of burst fractures associated with neurological injury is controversial, many investigators have reported favourable results with anterior decompression and stabilization surgery. The other major pathology of spine for which anterior decompression and stabilization surgery is favoured at present is Caries spine. AIM: To evaluate the effectiveness of anterior decompression and stabilisazion of dorsolumbar spine in terms of 1. Neurological recovery, 2. Kyphotic angle correction, 3. Bone graft fusion, 4. Pain scale of denis, and 5. Work scale of denis. MATERIALS AND METHODS: Twenty two patients who were operated with anterior decompression and stabilization of thoracolumbar spine pathology in Govt. General Hospital, Chennai with follow up of minimum six months were included in the study. Among those operated with anterior decompression and stabilization, Dorsolumbar burst fractures - 12 cases, Caries spine - 10 cases. The interval from injury to surgery was an average 18 days in burst fracture pts. The average duration of caries spine with which they presented to us was 3.2 months. Inclusion Criteria- We included cases of burst fracture affecting dorsal and lumbar vertebrae presenting with neurologic deficit and canal compromise >50%. Tuberculous spondylitis affecting dorsal and lumbar vertebra are also included. The indication for surgery were neurologic deficit, vertebral body destruction with significant angulation with or without cold abscess. All caries spine patients took ATT for a minimum period of 6 months. Exclusion Criteria - Patients with no neurologic deficit and those with severe medical comorbidities were excluded from the study. RESULTS: All the patients included in the study had preoperative neurologic deficits. In trauma spine, out of 12 cases, 5 cases, (41.6%) with incomplete spinal cord, injury improved to Frankel grade D/E neurology (walking with/without support). Out of 5 cases, one case had injury at D-12 level other had injury below L1 level. 7 cases (58.3%) with complete spinal cord injury remained the same at follow up. CONCLUSION: Anterior decompression and stablisation with anterior instrumentation with single rod system, - definitely improves neurology in incomplete spinal cord injury patients and most of caries spine patients. - though the kyphotic correction achieved is low, functionally (pain & work scale wise) patient has little difficulty

The Versatile Approach: A Novel Single Incision Combined with Anterior and Posterior Approaches for Decompression and Instrumented Fusion to Treat Tuberculosis of the Thoracic Spine

Study DesignRetrospective case series.PurposeTo describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes.Overview of LiteratureTuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages.MethodsTotally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the “Versatile approach”. Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula.ResultsThe study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3–82 years) and a mean follow-up of 60.23±24.56 months (range, 18–156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident.ConclusionsThe “Versatile approach” is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome

The effect of tualang honey in chronic exposure of high cholesterol diet in animal model

Introduction: Hyperlipidaemia accompanies chronic renal disease either as a consequence of the renal dysfunction or as part of generalized metabolic derangements. The aim of this study was to determine the effects of tualang honey (TH) on the kidneys of animal model with chronic exposure to high cholesterol diet. Materials and method: Twenty Sprague-Dawley rats were divided into two groups, the high cholesterol diet (12% CD (n= 16) and standard diet (SD) (n=4) and were fed for 12 weeks. After 12 weeks, the rats in the 12% CD group were subsequently divided into four groups. The first group was continued with only 12% CD while the other 3 groups in addition to the 12% CD, they were given TH treatment at different concentrations (1.2, 2.4 and 3.0 g/kg/day) for 4 weeks. Biochemical analysis of lipid profile and renal function were performed at the end of the experiment. The animals were sacrificed and the kidneys were harvested for histological examination. Results: In the 12 weeks HCD group, the serum cholesterol, LDL-c and creatinine levels were significantly higher) compared to that of the SD group. All groups with the tualang honey treatment had significant reduction in the LDL-c, triglyceride and creatinine levels. Histological examination of the kidney tissues of the HCD and HCD+TH groups at 16 weeks revealed segmental mesangial proliferation of some glomeruli with focal mesangial matrix expansion. No areas of periglomerular and peritubular fibrosis were observed. Conclusion: Tualang honey supplementation of animal model with chronic exposure to high cholesterol diet improved the renal function hence suggesting the its renoprotective effect. However, there were no changes seen in the histology of the kidneys . Additionally, tualang honey showed improvement in the LDL-c and triglyceride levels indicating its lipid lowering activities