Biological Stabilisation vs Mechanical Fixation: Do We Always Require Instrumentation in Anterior Decompression Surgeries for Thoracolumbar Spinal Tuberculosis?

Abstract

Study design: A retrospective cohort study.

Purpose: To compare the outcomes of anterior decompression with bone grafting alone and anterior decompression with bone grafting and fixation.

Methods: 93 patients with minimum 2 year follow-up were included in the study. 50 patients had undergone anterior decompression with bone grafting without instrumentation (group 1) and 43 patients with instrumentation (group 2). Both groups were compared using their demographic data, vertebral level of involvement, neurological recovery and progression of kyphotic deformity.

Results: Demographic data and pre-operative parameters were comparable in both groups. The mean (SD) of pre-operative kyphotic angle (in degrees) in group 1 was 29° (8.47°) and in group 2 was 29.81° (9.51°). The mean loss of correction at follow-up was 9.6° for group 1 compared to 3.4° for group 2. The mean loss of correction in patients of group 1 involving upper thoracic spine was 5.6°. There was no significant difference between the two groups across different age groups.

Conclusion: Use of anterior instrumentation for decompression surgeries in cases of tubercular spine have shown significantly better results compared to strut grafting alone with respect to restricting the progression of kyphotic deformity at follow-up. Instrumentation may be avoided in patients older than 60 years of age and those involving the upper thoracic spine, more so if both of these co-exist. However, further studies are needed to make our patient selection more rational, so as to avoid the failures and complications of this morbid procedure.

Supplementary information: The online version contains supplementary material available at 10.1007/s43465-023-00827-4.

Keywords: Anterior decompression; Kyphosis; Paraplegia; Potts spine; Spinal tuberculosis; Strut grafting.

Fig. 1

Patient flow diagram

Fig. 2

A Intraoperative photograph showing fixation using screw-rod construct through anterior transthoracic approach. B Incision site after closure and chest tube in situ

Fig. 3

A, B Plain radiograph of 35-year male with active thoracolumbar tuberculosis of D12–L1 vertebrae showing local vertebral destruction and kyphotic deformity. C, D T2-weighted sagittal and axial section of MRI showing abscess, vertebral destruction and cord compression. E Post-operative radiograph after anterior decompression and instrumentation with strut grafting showing excellent correction of deformity

Fig. 4

A Pre-operative lateral radiograph of a 62-year male patient showing vertebral body destruction and deformity at D10–D11. B Immediate post-operative radiograph after anterior decompression and bone grafting with instrumentation showing excellent correction of deformity. C Follow-up radiograph showing loss of correction and implant cut out