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A new classification and guide for surgical treatment of spinal tuberculosis

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Abstract

So far, there is no widely accepted classification system based on objective findings that can serve as a guide in selecting the treatment method for spinal tuberculosis. This retrospective study evaluates patients with spinal tuberculosis (Pott’s disease) treated with different surgical procedures. Our aim was to outline a new classification of spinal tuberculosis. A retrospective review of 76 cases (55 male and 25 female patients) of spinal tuberculosis was conducted. Five of the patients were treated medically, and the others who were treated surgically were classified into three types (I, II and III) according to the new classification system for spinal tuberculosis. All 76 patients were classifiable by this new system. The most common complication observed was local kyphosis (maximum 8 degrees) in type-II patients, but none of the patients needed correction. No neurological deterioration was observed in any of the cases. This new classification system helps in differentiating the various manifestations of spinal tuberculosis and appears to correlate with the surgical treatment of spinal tuberculosis. We believe that this new classification system can be used as a practical guide in the treatment of Pott’s disease.

Résumé

Il n’y a pas de système permettant de classer de façon objective les méthodes de traitement de la tuberculose osseuse. Cette étude rétrospective évalue les patients présentant une maladie de Pott, traités avec différentes techniques dans le but avoué de mettre en évidence une nouvelle classification de cette pathologie. Une étude rétrospective de 76 cas (55 hommes et 25 femmes) de tuberculose osseuse a été réalisée. Cinq patients ont été traités médicalement, les autres chirurgicalement en les classant en trois types A, B et C, selon la nouvelle classification. Les 76 patients ont été classés avec ce nouveau système. La complication la plus habituelle observée a été la cyphose locale (max. 8°) dans les types II. Mais il n’a pas été nécessaire chez ces patients de réaliser une correction chirurgicale. Nous n’avons observé aucune détérioration sur le plan neurologique. Cette nouvelle classification permet de différencier les différentes manifestations de la tuberculose osseuse et permet de faire une corrélation avec le traitement chirurgical. Nous espérons qu’elle pourra être utilisée et réaliser ainsi un guide pratique du traitement du mal de Pott.

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References

  1. Al Muhlim F, Ibrahim E, El Hassan A (1995) Magnetic resonance imaging of tuberculous spondylitis. Spine 20:2287–2292

    Google Scholar 

  2. Alothman A, Memish ZA, Awada A, et al (2001) Tuberculous spondylitis: analysis of 69 cases from Saudi Arabia. Spine 26:E565–570

    Article  PubMed  CAS  Google Scholar 

  3. Al Sebai MW, Al-Khawashki H, Al-Arabi K, et al (2001) Operative treatment of progressive deformity in spinal tuberculosis. Int Orthop 25:322–325

    Article  Google Scholar 

  4. Bidstrup C, Andersen PH, Skinhoj P, Andersen AB (2002) Tuberculous meningitis in a country with low incidence of tuberculosis. Scand J Infect Dis 34:811–814

    Article  PubMed  Google Scholar 

  5. Boachi-Adjei O, Squillante RG (1996) Tuberculosis of the spine. Orthop Clin North Am 27:95–103

    Google Scholar 

  6. Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL (2002) Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop 398:50–59

    Article  PubMed  Google Scholar 

  7. Dinc H, Sari A, Yalug G, Gumele HR (1996) CT-guided drainage of multilocular pelvic and gluteal tuberculosis abscesses. Case Report. AJR 167:667–668

    Google Scholar 

  8. Faraj AA (2001) Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Jt Surg Am 83:463–464

    Google Scholar 

  9. Fukuta S, Miyamoto K, Masuda T, et al (2003) Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine 28:E302–308

    Article  PubMed  Google Scholar 

  10. Ghadouane M, Elmansari O, Bousalmame N, Lezrek K, Aouam H, Moulay I (1996) Role of surgery in the treatment of Pott’s disease in adults. Apropos of 29 cases. Rev Chir Orthop Repar Appar Mot 82:620–628

    CAS  Google Scholar 

  11. Gopalakrishnan D, Krishna KN (2002) Cervicothoracic junction spinal tuberculosis presenting as radiculopathy. Neurol India 50(1):93–94

    PubMed  CAS  Google Scholar 

  12. Govender S, Parbhoo AH (1999) Support of the anterior column with allografts in tuberculosis of the spine. J Bone Jt Surg, Br Vol 81:106–109

    Article  CAS  Google Scholar 

  13. Govender S, Parbhoo AH, Kumar K (2001) Tuberculosis of the cervicodorsal junction. J Pediatr Orthop 21(3):285–287

    Article  PubMed  CAS  Google Scholar 

  14. Guven O, Kumano K, Yalcin S (1994) A single-stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine 19:1039–1043

    Article  PubMed  CAS  Google Scholar 

  15. Hosoglu S, Geyik MF, Balik I, et al (2002) Predictors of outcome in patients with tuberculous meningitis. Int J Tuberc Lung Dis 6:64–70

    PubMed  CAS  Google Scholar 

  16. Huang TJ, Hsu RW, Chen SH, Liu HP (2000) Video-assisted thoracoscopic surgery in managing tuberculous spondylitis. Clin Orthop 379:143–153

    Article  PubMed  Google Scholar 

  17. Jain R, Sawhney S, Berry M (1993) Computed tomography of vertebral tuberculosis: patterns of bone destruction. Clin Radiol 47:196–199

    Article  PubMed  CAS  Google Scholar 

  18. Kim DJ, Yun YH, Moon SH, Riew KD (2004) Posterior instrumentation using compressive laminar hooks and anterior interbody arthrodesis for the treatment of tuberculosis of the lower lumbar spine. Spine 29:E275–279

    Article  PubMed  Google Scholar 

  19. Korkusuz F, Islam C, Korkusuz Z (1997) Prevention of postoperative late kyphosis in Pott’s disease by anterior decompression and intervertebral grafting. World J Surg 21:524–528

    Article  PubMed  CAS  Google Scholar 

  20. Kumar K (1985) A clinical study and classification of posterior spinal tuberculosis. Int Orthop 9:147–152

    Article  PubMed  CAS  Google Scholar 

  21. McLain RF, Isada C (2004) Spinal tuberculosis deserves a place on radar screen. Clevel Clin J Med 71:537–549

    Article  Google Scholar 

  22. Medical Research Council Working Party on Tuberculosis of Spine (1999) Five year assessment of controlled trials of short-course chemotherapy regimens of 6, 9 or 18 months duration for spinal tuberculosis in patients ambulatory from the start of undergoing radical surgery: fourteenth report of the Medical Research Council Working Party on Tuberculosis of the Spine. Int Orthop 23:73–81

    Google Scholar 

  23. Mehta JS, Bhojraj SY (2001) Tuberculosis of thoracic spine. J Bone Jt Surg Br 83:859–863

    Article  CAS  Google Scholar 

  24. Moon MS (1997) Tuberculosis of the spine: controversies and a new challenge. Spine 22:1791–1797

    Article  PubMed  CAS  Google Scholar 

  25. Moon MS, Moon YW, Moon JL, Kim SS, Sun DH (2002) Conservative treatment of tuberculosis of the lumbar and lumbosacral spine. Clin Orthop 398:40–49

    Article  PubMed  Google Scholar 

  26. Mückley T, Schütz T, Kirschner M, Potulski M, Hofmann G, Bühren V (2003) Psoas abscess: the spine as a primary source of infection. Spine 28:E106–113

    Article  PubMed  Google Scholar 

  27. Ozdemir HM, Us AK, Ogun T (2003) The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine 28:474–479

    Article  PubMed  Google Scholar 

  28. Rajasekaran S (2002) The problem of deformity in spinal tuberculosis. Clin Orthop 398:85–92

    Article  PubMed  Google Scholar 

  29. Rezai AR, Lee M, Cooper PR (1995) Modern management of spinal tuberculosis. Neurosurgery 36:87–97

    Article  PubMed  CAS  Google Scholar 

  30. Upadhyay SS, Sell P, Saji MS (1994) Surgical management of spinal tuberculosis in adults. Clin Orthop 302:173–182

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedic Surgery, Gulhane Military Medical Academy, Etlik, 06018, Ankara, Turkey

    E. Oguz, A. Sehirlioglu, M. Altinmakas & M. Komurcu

  2. Department of Orthopedic Surgery, Turkish Armed Forces Rehabilitation and Care Center, Ankara, Turkey

    C. Ozturk

  3. Department of Orthopedics and Traumatology, Haydarpasa Training Hospital, Istanbul, Turkey

    C. Solakoglu

  4. Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, 19107, USA

    A. R. Vaccaro

Authors
  1. E. Oguz
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  2. A. Sehirlioglu
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  3. M. Altinmakas
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  4. C. Ozturk
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  5. M. Komurcu
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  6. C. Solakoglu
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  7. A. R. Vaccaro
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Correspondence to E. Oguz.

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Oguz, E., Sehirlioglu, A., Altinmakas, M. et al. A new classification and guide for surgical treatment of spinal tuberculosis. International Orthopaedics (SICO 32, 127–133 (2008). https://doi.org/10.1007/s00264-006-0278-5

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  • DOI: https://doi.org/10.1007/s00264-006-0278-5

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