J Neurosurg Spine, April 1, 2007; 6(4): 320-6.

Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients.
NA Sai Kiran, S Vaishya, SS Kale, BS Sharma, and AK Mahapatra Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.

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OBJECT: Significant numbers of patients with spinal Related Articles in Medline tuberculosis (TB), especially in developing countries, still Articles in Medline by Author: present late after disease onset with severe neurological Sai Kiran, NA deficits. The authors conducted a study to assess the outcome Vaishya, S in these patients. METHODS: Fifty-nine patients with spinal Kale, SS TB and severe motor deficits underwent surgery at the authors' center during the past 10 years. Data obtained in 48 Sharma, BS patients with a minimum of 3 months of follow up (mean Mahapatra, AK follow-up period 12.8 months) were analyzed. The disease in 34 patients was characterized by Frankel Grade A/B (Medical Research Council Grade 0/5) and in 14 patients by Frankel Grade C (unable to walk even with support) at admission. Thirty (88%) of the 34 patients with Frankel Grade A/B status and 13 (92.8%) of the 14 patients with Frankel Grade C status at admission experienced improvement to Frankel Grade D/E (walking with or without support) at the last follow-up examination 3 or more months after surgery. The degree of improvement exhibited by patients with a Frankel Grade A/B spinal cord injury was comparable to that shown by patients with Frankel Grade C status. Even patients with flaccid paraplegia, gross sensory deficit, prolonged weakness, spinal cord signal changes demonstrated on magnetic resonance imaging, and bladder involvement have experienced dramatic improvement in motor function since surgery. A significant number of the patients have shown remarkable improvement in other symptoms such as pain (91.6%), spasticity (88%), and bladder symptoms (88%). CONCLUSIONS: A significant proportion of patients with spinal TB and severe motor deficits experience remarkable improvement after surgical decompression and hence should undergo surgery even though they may be suffering from paraplegia of considerable duration.

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J Spinal Disord Tech, January 4, 2010; . Surgical Outcome of 2-stage (Posterior and Anterior) Surgical Treatment Using Spinal Instrumentation for Tuberculous Spondylitis.
A Hirakawa, K Miyamoto, T Masuda, S Fukuta, H Hosoe, N Iinuma, C Iwai, H Nishimoto, and K Shimizu Departments of *Orthopaedic Surgery daggerReconstructive Surgery for Spine, Bone and Joint, Gifu University Graduate School of Medicine double daggerDepartment of Orthopaedic Surgery, Gifu Prefectural General Medical Center section signReconstructive Surgery for Bone and Joint, Gifu University School of Medicine; and parallelDepartment of Orthopaedic Surgery, Gifu Central Hospital, Gifu, Japan.

MEDLINE ABSTRACT
STUDY DESIGN: A prospective study on the clinical outcomes in patients with tuberculous spondylitis treated by a 2-stage Download to Citation Manager operation (posterior and anterior) using posterior spinal instrumentation. OBJECTIVE: To evaluate the clinical outcomes of the 2-stage surgical treatment (first stage: Related Articles in Medline placement of posterior instrumentation and second stage: anterior debridement and bone grafting) for tuberculous Articles in Medline by Author: spondylitis. SUMMARY OF BACKGROUND DATA: There have been few reports describing the effects of 2-stage surgical Hirakawa, A treatment for tuberculous spondylitis. METHODS: Ten patients (5 men and 5 women) with tuberculous spondylitis were treated Miyamoto, K by 2-stage operations. Age at the initial operation was 64.6+/14.8 years (average+/-SD) (range: 47 to 83 y). The clinical Masuda, T outcomes were evaluated before and after the surgery in terms of hematologic examination, pain level, and neurologic status. Fukuta, S Bone fusion and changes in sagittal alignment were examined radiographically. RESULTS: All patients showed suppression of Hosoe, H infection, bony fusion, relief of pain, and recovery of neurologic function. No significant changes were observed in kyphosis Iinuma, N angle at the final follow-up. There were no incidences of severe complications or recurrence. CONCLUSIONS: Our results Iwai, C showed that posterior and anterior 2-stage surgical treatment for Nishimoto, H tuberculous spondylitis is a viable surgical option for cases in which conservative treatment has failed. However, the changes Shimizu, K in sagittal alignment showed that this strategy provides limited kyphosis correction.
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Thoracic and lumbar tuberculous spondylitis treated by posterior debridement, graft placement, and instrumentation: a retrospective analysis in 19 cases.
Gzey FK, Emel E, Bas NS, Hacisalihoglu S, Seyithanoglu MH, Karacor SE, Ozkan N, Alatas I, Sel B. Department of Neurosurgery, SSK Vakif Gureba Training Hospital, Istanbul, Turkey. fkarag@yahoo.com OBJECT: Surgical treatment of thoracic and lumbar tuberculous spondylitis is controversial. An anterior approach is usually recommended. The aim of the present study was to assess the efficacy of posterior debridement and the placement of posterior instrumentation for the treatment of patients with thoracic and lumbar tuberculous spondylitis. METHODS: Nineteen patients with thoracic and lumbar tuberculous spondylitis underwent single-stage posterior decompression and debridement as well as the placement of posterior interbody grafts if necessary, instrumentation and posterior or posterolateral grafts. No postoperative neurological deterioration was noted. One patient died of myocardial infarction on Day 10. The mean follow-up duration, excluding the one death, was 52.7 months (range 16-125 months). In a 70-year-old patient, a single pedicle screw broke after 3 months. All patients were in better neurological condition after surgery and at the last follow-up examination. Neurological deficits were present in only two patients at the last follow up (one American Spinal Injury Association Grade B and one Grade C deficit preoperatively). Three other patients suffered intermittent back or low-back pain. The mean angulation measured in 13 patients with kyphotic deformity was 18.2 degrees (range 5-42 degrees) preoperatively; this was reduced to 17.3 degrees (range 0-42 degrees) after surgery. There was a 2.8 degrees loss of correction (range 2-5 degrees) after 44.3 months (16-64 months). Kyphosis did not progress beyond 15 months in any patient. CONCLUSIONS: A posterior approach in combination with internal fixation and posterior or posterolateral fusion (with or without placement of posterior interbody grafts) may be sufficient for the debridement of the infection and to allow spinal stabilization in patients with thoracic and lumbar tuberculous spondylitis. This procedure is associated with easy access to the spinal canal for neural decompression, prevention of loss of corrected vertebral alignment in the long term, and facilitation of early mobilizatio