Exploring the Effectiveness of Transpedicular Fixation for Managing Thoracic and Lumbar Tuberculous Spine Disease
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Abstract
Background: Tuberculous spine disease, particularly in the thoracic and lumbar regions, poses a significant health challenge in Pakistan, necessitating effective surgical interventions. Transpedicular fixation has emerged as a promising treatment option, yet there is a paucity of comprehensive studies evaluating its efficacy within this demographic.
Objective: The study aimed to systematically assess the effectiveness of transpedicular fixation for treating thoracic and lumbar tuberculous spine disease in Pakistan by analyzing preoperative conditions, surgical details, and postoperative outcomes.
Methods: This retrospective cohort study involved 78 patients from the Neurosurgical Ward of Khyber Teaching Hospital, Peshawar, who underwent transpedicular fixation from January 2021 to December 2022. Demographics, preoperative clinical data, radiological findings, intraoperative details, and postoperative outcomes were collected. Statistical analysis was conducted using SPSS version 26, employing Chi-square and t-tests to evaluate outcome significance.
Results: The patient cohort comprised 53.85% males, with a mean age of 36.3 years. The lumbar region was the most affected (45%), followed by the thoracic (38%) and thoracolumbar (17%). Postoperative outcomes indicated an improvement in radiological stability from 48.72% preoperatively to 73.08% postoperatively (p=0.001), a non-significant increase in complications (12.82% to 19.23%, p=0.231), and a slight rise in patient satisfaction (84.62% to 88.46%, p=0.453).
Conclusion: Transpedicular fixation is effective in improving radiological stability and maintaining high patient satisfaction in the treatment of thoracic and lumbar tuberculous spine disease in Pakistan. The procedure's safety profile is acceptable, though the slight increase in postoperative complications warrants attention.
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References
Kumar V, Neradi D, Sherry B, Gaurav A, Dhatt SS. Tuberculosis of the spine and drug resistance: a review article. Neurosurgical Review. 2022 Feb;45(1):217-29.
Ibrahim EK, Ahmed EG, Elbadawi NE, Mohammed MM. Vertebral distribution of Pott's disease of the spine among adult Sudanese patients in Khartoum, Sudan. American Journal of Health Research. 2014;2(3):93-6.
Khanna K, Sabharwal S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. The Spine Journal. 2019 Nov 1;19(11):1858-70.
Pandita A, Madhuripan N, Pandita S, Hurtado RM. Challenges and controversies in the treatment of spinal tuberculosis. Journal of clinical tuberculosis and other mycobacterial diseases. 2020 May 1;19:100151.
Leonard Jr MK, Blumberg HM. Musculoskeletal tuberculosis. Tuberculosis and Nontuberculous Mycobacterial Infections. 2017 Jun 1:371-92.
Javed G, Laghari AA, Ahmed SI, Madhani S, Shah AA, Najamuddin F, Khawaja R. Development of criteria highly suggestive of spinal tuberculosis. World Neurosurgery. 2018 Aug 1;116:e1002-6.
Sciubba DM, Petteys RJ, Dekutoski MB, Fisher CG, Fehlings MG, Ondra SL, Rhines LD, Gokaslan ZL. Diagnosis and management of metastatic spine disease: a review. Journal of Neurosurgery: Spine. 2010 Jul 1;13(1):94-108.
Ruparel S, Tanaka M, Mehta R, Yamauchi T, Oda Y, Sonawane S, Chaddha R. Surgical management of spinal tuberculosis—the past, present, and future. Diagnostics. 2022 May 24;12(6):1307.
Bharathiraja P. Prospective study on Functional and Radiological Outcome of Tuberculosis of Dorsal and Lumbar Spine-Anterior Reconstruction and Posterior Stabilization through Posterior only approach (Doctoral dissertation, Madurai Medical College, Madurai).
Laksmana RD, Sahputra RE. The Role of Debridement and Spinal Fusion on Frankel Grade, ESR Levels, and CRP in Tuberculosis Spondylitis at Dr. M. Djamil General Hospital, Padang, Indonesia. Bioscientia Medicina: Journal of Biomedicine and Translational Research. 2022 Sep 5;6(11):2413-9.
Eldin MM, Ali AM. Lumbar transpedicular implant failure: a clinical and surgical challenge and its radiological assessment. Asian spine journal. 2014 Jun;8(3):281.
Corona-Cedillo R, Saavedra-Navarrete MT, Espinoza-Garcia JJ, Mendoza-Aguilar AN, Ternovoy SK, Roldan-Valadez E. Imaging assessment of the postoperative spine: an updated pictorial review of selected complications. BioMed Research International. 2021 May 18;2021:1-20.
Meyer-Szary J, Luis MS, Mikulski S, Patel A, Schulz F, Tretiakow D, Fercho J, Jaguszewska K, Frankiewicz M, Pawłowska E, Targoński R. The role of 3D printing in planning complex medical procedures and training of medical professionals—cross-sectional multispecialty review. International Journal of Environmental Research and Public Health. 2022 Mar 11;19(6):3331.
Zhang P, Peng W, Wang X, Luo C, Xu Z, Zeng H, Liu Z, Zhang Y, Ge L. Minimum 5-year follow-up outcomes for single-stage transpedicular debridement, posterior instrumentation and fusion in the management of thoracic and thoracolumbar spinal tuberculosis in adults. British Journal of Neurosurgery. 2016 Nov 1;30(6):666-71.
Nguyen Y, McNabb KC, Farley JE, Warren N. Examining family planning and adverse pregnancy outcomes for women with active tuberculosis disease: a systematic review. BMJ open. 2022 Mar 1;12(3):e054833.
Patil SR. A Comparative Study Between Functional Outcome of Short and Long Segment Transpedicular Fixation for Unstable Thoracolumbar Burst Fracture (Doctoral dissertation, Rajiv Gandhi University of Health Sciences (India)).
Tikhilov RM, Bazarov AY, Sergeev KS, Tsvetkova AK. 30 years of the journal" Traumatology and Orthopedics of Russia. Traumatology and Orthopedics of Russia. 2023 Jun 23;29(2):5-6.
Roy K. Functional outcomes of traumatic paraplegic spinal cord injury (SCI) patients at the time of discharge at CRP (Doctoral dissertation, Department of Physiotherapy, Bangladesh Health Professions Institute, CRP).
Li Z, Long H, Guo R, Xu J, Wang X, Cheng X, Huang Y, Li F. Surgical treatment indications and outcomes in patients with spinal metastases in the cervicothoracic junction (CTJ). Journal of Orthopaedic Surgery and Research. 2018 Dec;13(1):1-9.
Bilsky MH, Boland P, Lis E, Raizer JJ, Healey JH. Single-stage posterolateral transpedicle approach for spondylectomy, epidural decompression, and circumferential fusion of spinal metastases. Spine. 2000 Sep 1;25(17):2240-50.
Oh HS, Kim JS, Lee SH, Liu WC, Hong SW. Comparison between the accuracy of percutaneous and open pedicle screw fixations in lumbosacral fusion. The Spine Journal. 2013 Dec 1;13(12):1751-7.
Rexiti P, Abudurexiti T, Abuduwali N, Deng Q, Guo H. Debridement and internal fixation from a single posterior approach for the treatment of lumbosacral tuberculosis. World Neurosurgery. 2018 Dec 1;120:e392-9.
Alam W, Shah FA, Jan R, Khan MA, Shah A, Aziz A. Outcome of spine fixation for unstable fractures at dorsolumbar junction including fractured vertebrae in pedicular screw fixation. Pak J Surg. 2018;34(4):333-6.
El-Mor ES, Ragab A, Mansour ME. Transpedicular Screw Fixation for Degenerative Lumbar Spine Stenosis with Segmental Instability. The Egyptian Journal of Hospital Medicine. 2019 Jul 1;76(3):3791-6.