Combined Anterior Decompression Research Articles

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit.

A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion. A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity. The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively. Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity. 2.

Outcome analysis of surgically managed unstable burst fracture

&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Background:&lt;/span&gt;&lt;/strong&gt;Burst fractures are common injuries of dorsolumbar spine. In indicated cases, surgery is the treatment of choice. Significant controversy exists regarding surgical intervention for these fractures. Posterior decompression, anterior decompression and instrumentation, and combined anterior decompression and posterior instrumentation have been recommended in various studies. Here we are going to evaluate unstable burst fractures of thoracic and lumbar spine treated by isolated anterior decompression and instrumented fusion with TSM-Bone graft composite.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Methods:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Prospective study of thirty-six cases of unstable fracture of thoracic and lumbar spine treated in Sri Ramachandra Medical centre from January 2011 to January 2014. The inclusion criteria were burst fractures of thoracic or lumbar spine complete or incomplete neurological deficit and burst fractures of thoracic or lumbar spine without neurological deficit but with mechanical instability. The exclusion criteria were pathological fractures, chance fracture, stable burst, wedge compression and osteoporotic compression fractures. The results were analyzed during the follow-up using the Pain – Visual analogue scale, Fusion status and radiographic parameter – K-angle .For pain score were given as 3,2,1 for absent, moderate and severe pain respectively. Regarding fusion status score of 3,2,1 were given when fusion was good, fair and no sign of fusion respectively.&lt;strong&gt;&lt;/strong&gt;&lt;/span&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Results:&lt;/span&gt;&lt;/strong&gt;Mean pre-operative K-angle was 28o. Average loss of correction at final follow up was 3o.Mean correction of K-angle was 140.Moderate to severe loss of correction of K- angle was observed in 4 patients. Mild to moderate pain in 5 patients treated with analgesics. Average TSM subsidence was 3mm.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;Conclusions:&lt;/span&gt;&lt;/strong&gt;Bone graft composite provides stable biomechanical support to deficient anterior column in burst fractures and allows early rehabilitation and mobilization. Neural recovery may occur after anterior decompression, stabilization and fusion with TSM-Bone graft composite in dorsolumbar burst fractures with incomplete cord injury.&lt;/p&gt;

当センターにおけるＣｈａｎｃｅ型骨折の検討

We have had experience in treating 18 cases of Chance type fractures. The dominant feature of this fracture is a horizontal fracture involving the posterior element with little or no compression of the vertebral body. In our cases, 4 cases had bony fragments retropulsed from posterior wall. These may be classified to burst fracture. Two cases had rotation and displacement of the vertebral body. These may be classified to fracture dislocation. Surgical treatment with transpedicular fixation was done in 9 cases. For cases with burst fracture, combined anterior decompression and fusion was done.