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Journals / Acta Orthopaedica et Traumatologica Turcica / 2008 / Cilt: 42 - Sayı: 5

Treatment strategy in tuberculous spondylitis: Long-term follow-up results of 55 patients

Tüberküloz spondilitinde tedavi stratejisi: 55 hastanın uzun dönem takip sonuçları

Osman GÜVEN
MURAT BEZER
NURİ AYDIN
İsmail Emre KETENCİ
Pages
334–343
DOI
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AI Summary & Key Takeaways

AI Insight
⚡ TL;DR(Too Long; Didn't Read)

Conclusion: This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.

📌 3 Key Takeaways

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Objective & Hypothesis:Objectives: We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with long-term treatment results.
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Key Findings & Data:Methods: The study included 55 adult patients (26 males, 29 females; mean age 50 years; range 23 to 71 years) with tuberculous spondylitis.
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Conclusion & Impact:Conclusion: This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.
🔬Design:Research Article
📍Scope:Comprehensive Sample
⚙️Variables:İzleme çalışmaları · Omurilik füzyonu · Tüberküloz

Abstract

Objectives: We evaluated our treatment algorithm used in adult patients with tuberculous spondylitis together with long-term treatment results. Methods: The study included 55 adult patients (26 males, 29 females; mean age 50 years; range 23 to 71 years) with tuberculous spondylitis. The patients underwent four different treatment methods including non-operative treatment (NO, 6 patients), posterior debridement, fusion and instrumentation (PDFI, 21 patients), anterior debridement, instrumentation and fusion (ADIF, 21 patients), and finally, urgent radical debridement (RD, 11 patients) due to financial limitations of the patients. All the patients received antituberculous therapy for 12 months. On presentation, 17 patients (30.9%) had neurologic deficits (ADIF, 6 patients; RD, 11 patients). Neurologic assessment was made according to the Frankel grading system. The results were evaluated with respect to kyphosis, sagittal balance, neurologic recovery, and patient satisfaction. The mean follow-up period was 95.3 months (range 66 to 114 months). Results: Radiographically, successful bone fusion was achieved in all the patients. Following treatment, all surgically treated groups exhibited decreases in the kyphotic angle. The mean correction was significantly greater in ADIF (17.5°) and PDFI (12.1°) groups compared to the RD group (4.9°) (p<0.05). Final increases in the kyphotic angle were 0.7°, 1.2°, 1.4°, and 1.6° in NO, PDFI, ADIF, and RD groups, respectively. The mean sagittal deviations in the first postoperative month were +2 mm, +11 mm, +12 mm, and +14 mm in NO, PDFI, ADIF, and RD groups, respectively, which remained unchanged till the end of follow-up. Complete neurologic recovery was obtained in all but one patient. All the patients expressed satisfaction with the treatment. No recurrences or reactivation of disease were observed. Conclusion: This study showed that, with appropriate patient selection, the results of NO, PDFI, and ADIF were satisfactory and comparable.

Özet

Amaç: Bu çalışmada, tüberküloz spondiliti tedavisinde erişkin hastalarda kullandığımız algoritma, hastaların uzun dönem takip sonuçlarıyla birlikte değerlendirildi. Çalışma planı: Tüberküloz spondiliti tanısı konan 55 erişkin hasta (26 erkek, 29 kadın; ort. yaş 50; dağılım 23-71) çalışmaya alındı. Hastalar dört ayrı tedavi grubunda değerlendirildi. Altı hastada cerrahi olmayan (CO) tedavi uygulanırken, 21 hastada posterior debridmanla (PDEF), 17 hastada anterior debridmanla (ADEF) enstrümantasyonlu füzyon uygulandı. On bir hastaya maddi yetersizlik nedeniyle enstrümantasyonsuz acil radikal debridman (RD) uygulandı. Antitüberküloz tedavi tüm gruplarda 12 ay sürdürüldü. Başvuru sırasında 17 hastada (%30.9) nörolojik defisit vardı. Bu hastalar ADEF (n=6) ve RD (n=11) gruplarındaydı. Nörolojik değerlendirmede Frankel skoru kullanıldı. Hastalar kifoz, sagital denge, nörolojik iyileşme ve ameliyattan memnuniyet düzeyi açısından değerlendirildi. Ortalama takip süresi 95.3 ay (dağılım 66-144 ay) idi. Sonuçlar: Tüm hastalarda radyografik olarak başarılı kemik füzyonu sağlandı. Tedaviden hemen sonra tüm cerrahi gruplarında kifoz açısında gerileme görüldü. Ortalama düzelme miktarı ADEF (17.5°) ve PDEF (12.1°) gruplarında RD (4.9°) grubuna göre anlamlı derecede fazla idi (p<0.05). Son kontrolde kifoz açısındaki artış CO, PDEF, ADEF ve RD gruplarında sırasıyla 0.7°, 1.2°, 1.4°, 1.6° idi. Ameliyat sonrası birinci aydaki ölçümlerde ortalama sagital sapma CO, PDEF, ADEF ve RD gruplarında sırasıyla +2 mm, +11 mm, +12 mm, +14 mm olarak ölçüldü ve son takibe kadar bu sapmalarda değişiklik olmadı. Bir hasta dışında bütün hastalarda tam nörolojik iyileşme sağlandı. Tüm hastaların uygulanan tedaviden memnun kaldığı görüldü. Takipler sırasında hastalık nüksü veya reaktivasyonu gözlenmedi. Çıkarımlar: Çalışmamızın sonuçları, uygun hasta seçimi ile CO, PDEF ve ADEF tedavilerinin başarılı olacağını göstermektedir

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Cite This Article

GÜVEN, O., BEZER, M., AYDIN, N., KETENCİ, İ. E. (2008). Treatment strategy in tuberculous spondylitis: Long-term follow-up results of 55 patients. Acta Orthopaedica et Traumatologica Turcica, Cilt: 42 - Sayı: 5, 334–343. https://ajindex.com/articles/354613

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