J Korean Soc Spine Surg.  2003 Jun;10(2):163-171. 10.4184/jkss.2003.10.2.163.

Safety and Efficacy of Metalic Implants in the Treatments of Tuberculous Spondylitis

• Shin BJ
• Lee JC
• Choi SW
• Ryu KH
• Cho YI
• Yoon TK
• Kim KJ
• Kim YI

• KMID: 2003214
• DOI: http://doi.org/10.4184/jkss.2003.10.2.163

Abstract

STUDY DESIGN: A retrospective study
OBJECTIVE
To analyze the safety and effectiveness of treatments using metallic implants in the tuberculous spondylitis. SUMMARY OF LITERATURE REVIEW: Residual kyphosis and loss of correction remain the major problems following surgery for tuberculous spondylitis. Several authors have used metallic implants for the prevention of these complications. However, the safety of metallic implants use in tuberculous spine infections are still controversial.
MATERIALS AND METHODS
Seventeen patients, who underwent surgery, and were stabilized by the use of a metallic implant for tuberculous spondylitis, and followed up for more than 1 year were included in this study. All patients were treated with combined anterior fusion (with or without mesh) and/or posterior pedicle screw instrumentation. The patients were followed up with serial plain radiographs, laboratory inflammatory parameters and neurological recovery.
RESULTS
The overall correction of the kyphotic deformity was initially 8.5 degrees, and loss of correction occurred at 5.8 degrees. Although some loss of correction occurred, even after the use of a metallic implant, clinically significant kyphotic deformity was effectively prevented. There were no cases of persistent infection or failure to control infection when the metallic implantation was combined with an anterior radical debridement and chemotherapy. The erythrocyte sedimentation rate and C-reactive protein were eventually normalized in all patients. The preoperative neurological deficits were: incomplete paralysis in 9 cases and radiculopathy in 4. At the final follow-up, 11 cases had completely recovered, partial residual neurological deficits remaining in 2.
CONCLUSIONS
The use of instrumentation with metallic implants, in tubercuous spondylitis of the spine, provided immediate stability, and did not prohibit the control of infection when combined with radical debridement and anti-tuberculous chemotherapy.

Keyword

Tuberculous spondylitis; Pedicle screw; Mesh

MeSH Terms

Blood Sedimentation
C-Reactive Protein
Congenital Abnormalities
Debridement
Drug Therapy
Follow-Up Studies
Humans
Kyphosis
Paralysis
Radiculopathy
Retrospective Studies
Spine
Spondylitis*
C-Reactive Protein

Figure

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  Fig. 1. A 31-year-old woman sustained spinal tuberculous spondylitis of thoracic spine and was treated with the combined anterior and posterior techinque. (A) Preoperative anteroposterior thoracolumbar spine radiograph shows asymmertrical collapsing of T8 vertebral body and paraspinal soft tissue bulging. On the lateral view, destruction of T8 vertebral body and focal kyphotic angulation was noted. (B) Magnetic resonance images showed extent of the lesion more clearly. Affected segment ranged from T6 to T9. Compression of spinal cord by an epidural mass was also evident. (C)(D) Radiographs obtained at postoperative 1-year follow-up shows solid fusion with pedicle screw instrumentation. Anterior fusion with iliac bone graft was per-formed from T6 to T9 and pedicle screws were not inserted to the affected vertebra.

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  Fig. 2. A 28-year-old woman who had tuberculous spondylitis at thoracolujmbar junction was treated with the combined anterior tita-nium mesh and posteior pedicle screw techinque. (A) (B) Preoperative radiographs show destruction of T12 vertebral body and obliteration of T12-L1 intervertebral disc space. (C)(D) Radiographs obtained at postoperative 2-year shows stable con-struct and solid fusion.

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