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

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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.

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Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

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Funding

The authors received no funding/grant from any external agencies.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

    Saurabh Singh

  2. Department of Orthopaedics and Spine Surgery, Ganga Medical Centre and Hospital, Coimbatore, Tamil Nadu, India

    R Dinesh Iyer

  3. Department of Orthopaedics, All India Institute of Medical Sciences, Raipur, India

    Alok Rai

  4. Department of Orthopaedics, Oxford Medical College and Research Centre, Bangalore, Karnataka, India

    Siddalingeshwara GI

  5. Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

    Divyansh Sharma

  6. Department of Orthopaedics, Fortis Hospital, Mohali, India

    Rishabh Surana

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  1. Saurabh Singh
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  2. R Dinesh Iyer
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  4. Siddalingeshwara GI
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Correspondence to R Dinesh Iyer.

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The authors declare that they have no conflict of interest.

Ethical Approval

All the procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (Institute ethics committee vide letter no. IMS-BHU(R)- ethics/1995) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Written and informed consent were taken from the patient and their family members for using his individual and clinical data for publication and research purposes.

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Informed consent was taken from all our patients and Institutional review board approval has also been taken.

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Singh, S., Iyer, R.D., Rai, A. et al. Biological Stabilisation vs Mechanical Fixation: Do We Always Require Instrumentation in Anterior Decompression Surgeries for Thoracolumbar Spinal Tuberculosis?. JOIO 57, 472–480 (2023). https://doi.org/10.1007/s43465-023-00827-4

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  • DOI: https://doi.org/10.1007/s43465-023-00827-4

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