Our Summary

The study examines a type of surgery for a specific spinal condition caused by tuberculosis. Traditionally, this surgery involves two parts: removing the infected areas and then fusing the spine both from the front (anterior) and the back (posterior). However, this research focuses on a different approach, only performing the fusion from the back, without the front reconstruction.

The study involved 57 patients who had spinal tuberculosis at one level of their spine and were experiencing symptoms related to spinal cord compression. They underwent a surgery where screws and rods were placed to stabilize the spine, the infected areas were removed, and the remaining healthy bone was fused together.

The researchers evaluated the patients’ improvement in spinal curvature (kyphosis) and neurological symptoms, and also checked how well the spinal fusion had held up at the 2-year mark. They found that the average improvement in spinal curvature was about 48% immediately after surgery, with a slight loss of correction (about 14%) after 2 years. The patients’ neurological symptoms also improved significantly.

The researchers concluded that this back-only fusion surgery can effectively treat this type of spinal tuberculosis, improve symptoms, and maintain the improvement over time. The degree of spinal damage did not seem to affect the neurological recovery or the improvement in spinal curvature.

FAQs

  1. What is the traditional approach to surgery for spinal tuberculosis, and how does the method studied differ?
  2. What improvements did the researchers observe in patients who underwent the back-only fusion surgery for spinal tuberculosis?
  3. Did the degree of spinal damage affect the neurological recovery or improvement in spinal curvature in patients who underwent the back-only fusion surgery?

Doctor’s Tip

A doctor might tell a patient undergoing spinal fusion surgery to follow their post-operative care instructions carefully, including physical therapy exercises and restrictions on certain activities to ensure proper healing and fusion of the spine. It’s also important to attend all follow-up appointments to monitor progress and address any concerns. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support the healing process and overall spine health.

Suitable For

Patients who are typically recommended spinal fusion surgery are those who have spinal conditions such as degenerative disc disease, spinal stenosis, scoliosis, or spinal fractures. In the case of spinal tuberculosis, patients with symptoms of spinal cord compression and infection at one level of the spine may also be recommended for spinal fusion surgery. This type of surgery may be considered when conservative treatments have not been effective in managing the symptoms and improving the patient’s quality of life.

Timeline

  • Before surgery: The patient experiences symptoms related to spinal cord compression, such as back pain, numbness or weakness in the limbs, and difficulty walking. They undergo diagnostic tests to confirm the presence of spinal tuberculosis and determine the extent of the infection.

  • Surgery: The patient undergoes a spinal fusion surgery where the infected areas of the spine are removed, and the remaining healthy bone is fused together using screws and rods placed from the back of the spine. The surgery aims to stabilize the spine and relieve pressure on the spinal cord to improve symptoms.

  • Immediately after surgery: The patient experiences an average improvement in spinal curvature of about 48% and a significant improvement in neurological symptoms. They are monitored closely in the hospital for any complications and are given pain medication and physical therapy to aid in their recovery.

  • 2 years post-surgery: The patient’s spinal curvature has maintained about 86% of the initial improvement, with a slight loss of correction (about 14%) over time. The patient’s neurological symptoms continue to show significant improvement, indicating the long-term success of the surgery in treating spinal tuberculosis and its associated symptoms.

Overall, the patient’s journey before and after spinal fusion surgery involves a period of symptoms and diagnostic tests, followed by the surgical procedure, immediate post-operative care, and long-term monitoring to assess the success of the surgery in improving symptoms and maintaining spinal stability.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with spinal fusion surgery for spinal tuberculosis?
  2. How long is the recovery process after spinal fusion surgery, and what can I expect during this time?
  3. Will I need physical therapy or rehabilitation after the surgery, and if so, for how long?
  4. What is the success rate of this back-only fusion surgery for spinal tuberculosis, and what are the long-term outcomes?
  5. How soon after the surgery can I expect to see improvement in my symptoms, such as spinal curvature and neurological issues?
  6. Are there any specific lifestyle changes or precautions I should take after the surgery to ensure the best outcome?
  7. Will I need any additional follow-up appointments or imaging studies to monitor the fusion and my overall spinal health?
  8. How experienced is the surgical team in performing this type of surgery, and what is their success rate with similar cases?
  9. Are there any alternative treatment options to consider for my condition, and how do they compare to spinal fusion surgery?
  10. What should I do if I experience any new or worsening symptoms after the surgery, and when should I seek immediate medical attention?

Reference

Authors: Basu S, Kondety SKC. Journal: Spine Deform. 2018 May-Jun;6(3):282-289. doi: 10.1016/j.jspd.2017.09.051. PMID: 29735138