An Analysis of 50 Operationsof the Vertebrectomy and Anterior Spinal Fusion for Treatment of Spinal Tuberculosis

Year 1974, Volume: 27 Issue: 3-4, 599 - 614, 30.12.1974

Güngör Sami Çakırgil

Abstract

The results in the first 50 clinical cases, 5 to 65 years old who had debridement and anterior spinal fusion for Pott's disease at the Orthopaedic department of Faculty of Medicine of Ankara University and Çankaya Hospital, Ankara, between
1964-1974 were reviewed retrospectively after fallow - ups from 1 to 10 years. The duration of symptoms prior to admission ranged İrom 3 months to five years. Forty three of the 50 cases had paraplegia and were first seen 1 month to 24 months and
avarage 9.3 months after the onset of their neural symptoms.
In the forty three patients with paraplegia, the causes of neural compression were found as: Bone seguestrum, caseous material pus, a seguestrated disc, a protruding ridge of bone produce by kyphoscoliosis, pachymeningitis and pus within the dura.
In our 50 clinical cases, after fallow-ups one to ten years, 37 (%74) patients showed solid fusion and healing of the tuberculous lesion, In 5 (%10) there was stabil non-unions and apperent healing of the disease. The remaining 8 (%16) were classified as having unstabl non - unions requiring further treatment.
Post operatively an apperant increase of kyphosis, as determined roentgencgraphically avarage ıncrease of 22.2 degreeswere notted. The causes of increasing kyphosis were slippage of the grafts, protrusion of the grafts into osteoporotic vertebral body and disc spaces, fracture of the grafts and overgrowth of
the posterior part of the fusion mass.
The post operative complications were : 3 superficial infections, 1 deep infections 10 fractures of the graft, 5 slippage of the graft, 4 post operative paralytic ileus (temporary) 1 cardiac arrest (a three year old boy had cardiac arrest right after the
operation, while transfering to strecher. Unfortunately he passed away).
The fallowing conclusions are offered:
1. The anterior approach gives direct, wide access to the diseased area and it is prossible to remove all pathological foci radicaliy.
2. Early decompression and anterior fusion is essential to avold further destruction which may result in severe kyphosis, paraplegia and impairment of cardiopulmonary function.
3 — Only and definite treatment of Pott's paraplegia can be obtained by anterior decompression and fusion.
4. In severe kyphotic cases, decompression of spinal cord
should be made through the postero -lateral approach.
5. An anterior interbody spinal fusion between more than two vertebral segments may cause instability and subluxation. In this kind of cases, a second operation, posterior fusion is employed 6 weeks later.
6. In the treatment of Pott's disease, evacuation of the contents of the abcess, combined with removal of all avascular bone and anterior fusion using strut grafts has given results superior to those obtained by other methods.

Keywords

Kyphoscoliosis , Vertebral tuberculosis , Spinal cord

Vertebral Tüberkülozun Tedavisinde Vertebrektomy Ve Anterior Spinal Füzyon Uyguladığımız 50 Vakanın Değerlendirilmesi

Abstract

Ankara Tıp Fakültesi Ortopedi ve Travmatoloji Kliniği ile Çankaya Hastanesinde 1964-1974 yılları arasında, vertebral tüberkülozdan muzdarip 50 vakaya cerrahi müdahalede bulunulmuş ve bu vakaların 1-10 yıllık takipleri yapılmıştır. Müdahale edilen ve yaş hudutları 2-65 olan hastaların Pre-operatif semptomlarının devamı, 3ay ilâ 5 yıl kaydedilmiştir. Parapleji tesbit edilen 43 hastada semptomların devamı, 1-24 ay ve ortalama 9.3 ay bulunmuştur. Bu 43 paraplejik hastada spinal kord kompresyonunun sebebi olarak: Abse, kaseöz materyel, sekestrize kemik ve disk; geç paraplejik vakalarda ise, ciddi kifo-skolioz'a bağlı mekanik baskı, pakimenengitis ve intradural invazyon kaydedilmiştir.
50 vakalık serimizde 1-10 yıl devam eden fallow-up tetkikinde: %74 ossöz füzyonla müterafıh başarı, %10 stabil non-union'a rağmen hastalığın sükün bulduğu ve %16 vakada da, unstabil non-union'la başarısızlık tesbit edilmiş ve bu gruptaki hastalar ilâvi tedaviler gerektirmiştir.
Post operatif olarak vakalarımızda vasati olarak %22.2 arasında mevcut kifozda bir artış görülmüş olup bunda, greflerin kayması, greflerin kırılması, komşu vertebraların porotik oluşu, disk içine penetre olan gref uçlarının rezorbsiyonu, greflerin posterior kısmında aşırı büyüme gibi faktörler sorumlu tutulmuştur.
Ameliyat sonu komplikasyonu clarak: 3 sathi infeksiyon, 1 derin infeksiyon, 10 gref kırılması 5 gref kayması, 4 geçici paralitik ileus, 1 kardiak arrest (Üç yaşındaki bir çocukta ameliyat bittikten sonra, hastanın sedyeye alınması sırasında oldu, bütün çalışmalara rağmen kurtarılması mümkün olamadı.)
Netice olarak, Vertebral Tüberkülozun tedavisinde :
1. Anterior apraç ile bütün hasta bölge radikal olarak temizlenir.
2. Erken anterior füzyon ile daha fazla harabiyet, kifoz, parapleji, kardiovasküler bozukluklar önlenir.
3. Paraplejinin yegane ve tam tedavisi imkânı, anterior dekompresyon ve füzyon ile sağlanır.
4. Ciddi kifetik vakalarda dekompresyon postero-later
apraçla yapılmalıdır.
5. Anterior apraçla stabilite bozukluğu veya subluksasyon gelişen vakalarda, 6 hafta sonra posterior füzyon ameliyatı da yapılmalıdır.

Keywords

Vertebral tüberküloz , Spinal kord , Kifoskolyoz

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