Pott's disease surgery: Difference between revisions
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===Surgical Options=== | ===Surgical Options=== | ||
*Surgical therapy for [[Pott's disease|spinal tuberculosis]] is by [[decompression]] of the cord with [[debridement]] of the infected tissue via the anterior or anterolateral approach.<ref name="pmid28083459">{{cite journal| author=Golwala P, Kapoor C, Shah M, Merh A, Kansagra A| title=A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique. | journal=Cureus | year= 2016 | volume= 8 | issue= 12 | pages= e915 | pmid=28083459 | doi=10.7759/cureus.915 | pmc=5218885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28083459 }} </ref> | *Surgical therapy for [[Pott's disease|spinal tuberculosis]] is by [[decompression]] of the cord with [[debridement]] of the infected tissue via the anterior or anterolateral approach.<ref name="pmid28083459">{{cite journal| author=Golwala P, Kapoor C, Shah M, Merh A, Kansagra A| title=A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique. | journal=Cureus | year= 2016 | volume= 8 | issue= 12 | pages= e915 | pmid=28083459 | doi=10.7759/cureus.915 | pmc=5218885 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28083459 }} </ref> | ||
*Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.<ref name="pmid28265884">{{cite journal| author=Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z et al.| title=Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis. | journal=Clin Orthop Relat Res | year= 2017 | volume= | issue= | pages= | pmid=28265884 | doi=10.1007/s11999-017-5306-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28265884 }} </ref><ref name="pmid28169940">{{cite journal| author=D'souza AR, Mohapatra B, Bansal ML, Das K| title=Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation. | journal=Clin Spine Surg | year= 2017 | volume= | issue= | pages= | pmid=28169940 | doi=10.1097/BSD.0000000000000498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28169940 }} </ref> | *Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.<ref name="pmid28265884">{{cite journal| author=Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z et al.| title=Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis. | journal=Clin Orthop Relat Res | year= 2017 | volume= | issue= | pages= | pmid=28265884 | doi=10.1007/s11999-017-5306-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28265884 }} </ref><ref name="pmid28169940">{{cite journal| author=D'souza AR, Mohapatra B, Bansal ML, Das K| title=Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation. | journal=Clin Spine Surg | year= 2017 | volume= | issue= | pages= | pmid=28169940 | doi=10.1097/BSD.0000000000000498 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28169940 }} </ref><ref name="pmid27792109">{{cite journal| author=Wang LJ, Zhang HQ, Tang MX, Gao QL, Zhou ZH, Yin XH| title=Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow-Up. | journal=Spine (Phila Pa 1976) | year= 2016 | volume= | issue= | pages= | pmid=27792109 | doi=10.1097/BRS.0000000000001955 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27792109 }} </ref> | ||
*[[Laminectomy]] for decompression is contraindicated in cases with anterior [[Pott's disease|spinal tuberculosis]], as it increases the unstability of the [[spine]].<ref name="pmid28112788">{{cite journal| author=Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F et al.| title=Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy. | journal=Orthopedics | year= 2017 | volume= | issue= | pages= 1-7 | pmid=28112788 | doi=10.3928/01477447-20170117-02 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28112788 }} </ref> | *[[Laminectomy]] for decompression is contraindicated in cases with anterior [[Pott's disease|spinal tuberculosis]], as it increases the unstability of the [[spine]].<ref name="pmid28112788">{{cite journal| author=Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F et al.| title=Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy. | journal=Orthopedics | year= 2017 | volume= | issue= | pages= 1-7 | pmid=28112788 | doi=10.3928/01477447-20170117-02 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28112788 }} </ref> | ||
Revision as of 14:43, 27 March 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Surgery
Indications for Surgery
The following are the indications for surgery in patients with Pott's disease:[1][2][3]
- Neurological deficits
- Potential mechanical instability
- Kyphosis leading to sagittal imbalance or severe kyphosis ≥60°
- Large thoracic spine abscess casing esophageal obstruction or cervical abscess causing difficulty in breathing
- Abscess increasing in size even after 3 to 6 months of standard medical therapy
- Worsening neurological function during the period of medical therapy
- Children ≤7 years of age, with three or more affected vertebral bodies
Surgical Options
- Surgical therapy for spinal tuberculosis is by decompression of the cord with debridement of the infected tissue via the anterior or anterolateral approach.[4]
- Anterior transposition of cord with shaving of the internal gibbus can be performed in patients with severe kyphotic deformities with compression of the cord.[5][6][7]
- Laminectomy for decompression is contraindicated in cases with anterior spinal tuberculosis, as it increases the unstability of the spine.[8]
References
- ↑ Wang YX, Zhang HQ, Li M, Tang MX, Guo CF, Deng A; et al. (2017). "Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only". Injury. 48 (2): 378–383. doi:10.1016/j.injury.2016.12.025. PMID 28063678.
- ↑ Liu JM, Zhou Y, Peng AF, Chen XY, Chen WZ, Long XH; et al. (2017). "One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft". Clin Neurol Neurosurg. 153: 67–72. doi:10.1016/j.clineuro.2016.12.013. PMID 28056436.
- ↑ Peng L, Hai N (2016). "The effect of time-to-surgery on outcome in patients with neurological deficits caused by spinal tuberculosis". Turk Neurosurg. doi:10.5137/1019-5149.JTN.18736-16.1. PMID 27990623.
- ↑ Golwala P, Kapoor C, Shah M, Merh A, Kansagra A (2016). "A Case of Koch's Spine Treated with Modified Transpedicular Vertebral Curettage and Posterior Fixation: A Novel Technique". Cureus. 8 (12): e915. doi:10.7759/cureus.915. PMC 5218885. PMID 28083459.
- ↑ Pan Z, Luo J, Yu L, Chen Y, Zhong J, Li Z; et al. (2017). "Débridement and Reconstruction Improve Postoperative Sagittal Alignment in Kyphotic Cervical Spinal Tuberculosis". Clin Orthop Relat Res. doi:10.1007/s11999-017-5306-9. PMID 28265884.
- ↑ D'souza AR, Mohapatra B, Bansal ML, Das K (2017). "Role of Posterior Stabilization and Transpedicular Decompression in the Treatment of Thoracic and Thoracolumbar TB: A Retrospective Evaluation". Clin Spine Surg. doi:10.1097/BSD.0000000000000498. PMID 28169940.
- ↑ Wang LJ, Zhang HQ, Tang MX, Gao QL, Zhou ZH, Yin XH (2016). "Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow-Up". Spine (Phila Pa 1976). doi:10.1097/BRS.0000000000001955. PMID 27792109.
- ↑ Li J, Huang X, Chen F, Dai F, Zhou Q, Luo F; et al. (2017). "Computed Tomography-Guided Catheterization Drainage to Cure Spinal Tuberculosis With Individualized Chemotherapy". Orthopedics: 1–7. doi:10.3928/01477447-20170117-02. PMID 28112788.