Outcomes of Dorsolumbar and Lumbar Spinal Tuberculosis Treated by Minimally Invasive and Open Techniques: A Prospective Comparative Study

Abstract

Purpose of study: To compare the outcomes of minimally invasive and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB).

Methods: Skeletally mature patients with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included. Healed and mechanically stable STB, patients having severe hepatic and renal impairment, coexisting spinal conditions such as ankylosing spondylitis and rheumatoid arthritis, and patients unwilling to participate were excluded from the study. The patients were divided in to two groups, group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 24 months.

Results: A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs 742 ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (16° vs 33.25°) was significantly better in group B. Rest of the parameters such as duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups.

Conclusion: MIS stabilization when compared to open techniques is associated with significant improvement in immediate post-operative VAS scores. The MIS approaches at 2-year follow-up have functional results similar to open techniques. MIS is inferior to open techniques in kyphosis correction and may be associated with complications.

Keywords: Minimally invasive spine surgery; Open decompression; Posterior instrumentation; Spinal tuberculosis.

Fig. 1

Flowchart showing selection of the patients.

Fig. 2

Pre-operative AP and lateral X-ray of Spinal Tuberculosis (L1-L2) treated by open technique (A); Pre-operative MRI and CT Scan sagittal and axial view (B); Immediate post-operative view (C); Follow up X-ray at 6 months (D); Final follow-up (E)

Fig. 3

Pre-operative AP and lateral X-ray of Spinal Tuberculosis (L4-L5) treated by MIS technique (A); Pre-operative MRI scan sagittal and axial view (B, C); Immediate post-operative view (D); Follow up X-ray at 6 months (E); Final follow-up (F)

Fig. 4

Pre-operative AP and lateral X-ray of Spinal Tuberculosis (L3-L4) (A); Pre-operative MRI and CT Scan sagittal and axial view (B); Immediate post-operative view (C); Follow up X-ray at 6 months showing failure (D); Immediate revision post-operative view (E); Follow up X-ray after revision at 6 months (F); Final follow-up (G)