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Research ArticleOther & Special Categories

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Ujjwal K. Debnath, Jeffrey R. McConnell and Sishir Kumar
International Journal of Spine Surgery May 2021, 8081; DOI: https://doi.org/10.14444/8081
Ujjwal K. Debnath
1Ramakrishna Mission Seva Pratisthan, Kolkata, India
MS(Orth), FRCSG, FRCS(Tr & Orth), DM(Orth) University of Nottingham, CCT-UK
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Jeffrey R. McConnell
2Fortis Hospital, Kolkata, India
MD
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Sishir Kumar
3Metro Hospital, New Delhi, India
MS(Gen Surg), Dip Ortho, MCh(Ortho)
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ABSTRACT

Background A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion.

Methods A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity.

Results The mean age was 37.8 years (range, 2–65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group.

The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively.

Conclusions Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity.

Level of evidence 2.

  • spine tuberculosis
  • neurological deficit
  • combined anterior and posterior surgery (A-P)
  • spinal fusion

Footnotes

  • Disclosures and COI: The authors received no funding for this study and report no conflicts of interest.

  • This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2021 ISASS
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit
Ujjwal K. Debnath, Jeffrey R. McConnell, Sishir Kumar
International Journal of Spine Surgery May 2021, 8081; DOI: 10.14444/8081

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Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit
Ujjwal K. Debnath, Jeffrey R. McConnell, Sishir Kumar
International Journal of Spine Surgery May 2021, 8081; DOI: 10.14444/8081
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Keywords

  • spine tuberculosis
  • neurological deficit
  • combined anterior and posterior surgery (A-P)
  • spinal fusion

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