PDF icon Download PDF
Open Access
CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2023; 58(03): 404-409
DOI: 10.1055/s-0042-1750834
Artigo Original
Coluna

Estudo observacional prospectivo sobre os desfechos da descompressão posterior e fixação em estágio único na tuberculose da coluna dorsolombar

Article in several languages: português | English
Hari J. Menon
1   Departamento de Ortopedia, Hospital Civil de Surat, Surat, Gujarat, Índia
,
Aditya V. Tripathi 
1   Departamento de Ortopedia, Hospital Civil de Surat, Surat, Gujarat, Índia
,
Nrutik M. Patel
1   Departamento de Ortopedia, Hospital Civil de Surat, Surat, Gujarat, Índia
,
Chandan Narang
1   Departamento de Ortopedia, Hospital Civil de Surat, Surat, Gujarat, Índia
› Author Affiliations
Suporte Financeiro Não houve suporte financeiro de fontes públicas, comerciais ou sem fins lucrativos.
› Further Information
Also available ateRef
  Permissions and Reprints
Preview

Resumo

Objetivo Estudar os desfechos da descompressão posterior isolada e instrumentação na tuberculose da coluna dorsal e dorsolombar.

Métodos Os pacientes (n = 30) incluídos neste estudo apresentavam tuberculose na coluna dorsal ou dorsolombar, acompanhada ou não por déficit neurológico e/ou deformidade. Todos os 30 pacientes foram tratados apenas por descompressão posterior e instrumentação. Estudamos a correção e manutenção da deformidade na coluna dorsal e dorsolombar, o desfecho funcional segundo o índice de deficiência de Oswestry (ODI) e a escala visual analógica (EVA); o desfecho neurológico foi estudado de acordo com a classificação de Frankel.

Resultados Na atual série, 30 pacientes foram submetidos à descompressão posterior e instrumentação em estágio único e apresentaram melhora significativa no estado neurológico e desfecho funcional segundo os scores de ODI, EVA e classificação de Frankel.

Conclusão A abordagem posterior (extracavitária) permite o acesso ideal aos aspectos laterais e anteriores da medula espinhal para uma boa descompressão. Facilita a mobilização precoce, evita problemas associados ao decúbito prolongado, proporciona melhor desfecho funcional e corrige a cifose no plano sagital de maneira significativamente melhor.

Palavras-chave

coluna de Koch - abordagem posterior - coluna de Pott - espondilodiscite


Publication History

Received: 03 February 2022

Accepted: 28 April 2022

Article published online:
14 July 2022

© 2022. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • Referências

  • 1 Tuli SM. Tuberculosis of the skeletal system. 6th ed. New Delhi: Jaypee Brothers Medical Pub; 2020
    Search in Google Scholar
  • 2 Jain AK, Dhammi IK, Prashad B, Sinha S, Mishra P. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg Br 2008; 90 (11) 1477-1481
    Search in Google Scholar
  • 3 Garg RK, Somvanshi DS. Spinal tuberculosis: a review. J Spinal Cord Med 2011; 34 (05) 440-454
    Search in Google Scholar
  • 4 Hee HT, Majd ME, Holt RT, Pienkowski D. Better treatment of vertebral osteomyelitis using posterior stabilization and titanium mesh cages. J Spinal Disord Tech 2002; 15 (02) 149-156 , discussion 156
    Search in Google Scholar
  • 5 Goel MK. Treatment of Pott's paraplegia by operation. J Bone Joint Surg Br 1967; 49 (04) 674-681
    Search in Google Scholar
  • 6 Seddon HJ. Pott's paraplegia: prognosis and treatment. Br J Surg 1934; 22 (88) 769-799
    Search in Google Scholar
  • 7 Donaldson JR, Marshall CE. Pott's disease (Experience with 560 operated cases). Indian J Surg 1965; 27: 765-773
    Search in Google Scholar
  • 8 Lee TC, Lu K, Yang LC, Huang HY, Liang CL. Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction. J Neurosurg 1999; 91 (2, Suppl) 163-169
    Search in Google Scholar
  • 9 Standring S. Gray's anatomy. The anatomical basis of clinical practice. 39th ed. Philadelphia: Churchill Livingstone; 2004
    Search in Google Scholar
  • 10 Hodgson AR, Stock FE. Anterior spinal fusionfor the treatment of tuberculosis of spine. J Bone Joint Surg 1960; 42 (02) 295-310
    Search in Google Scholar
  • 11 Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine 1997; 22 (15) 1791-1797
    Search in Google Scholar
  • 12 Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 1989; 71 (09) 1314-1323
    Search in Google Scholar
  • 13 Sundararaj GD, Behera S, Ravi V, Venkatesh K, Cherian VM, Lee V. Role of posterior stabilisation in the management of tuberculosis of the dorsal and lumbar spine. J Bone Joint Surg Br 2003; 85 (01) 100-106
    Search in Google Scholar
  • 14 A controlled trial of débridement and ambulatory treatment in the management of tuberculosis of the spine in patients on standard chemotherapy. A study in Bulawayo, Rhodesia. J Trop Med Hyg 1974; 77 (04) 72-92
    Search in Google Scholar
  • 15 Shah M, Suthar K, Zala R. To study the outcomes of posterior decompression and fixation of tuberculosis of dorsolumbar spine. Int J Orthop Sci 2017; 3 (03) 691-695
    Search in Google Scholar
  • 16 Zeng H, Zhang P, Shen X. et al. One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases. BMC Musculoskelet Disord 2015; 16: 186
    Search in Google Scholar
  • 17 Islam MF, Akon MSI, Alom MI, Islam MZU, Hossain MY, Hossain MI. Evaluation of Outcome of Decompression and Transpedicular Screw Fixation in the Management of TB of the Thoracolumbar Spine. Med Today (Karachi) 2020; 32 (02) 104-111 cited 2022 Apr. 26 [Internet] from https://www.banglajol.info/index.php/medtoday/article/view/48823
    Search in Google Scholar
  • 18 Patidar AB, Mehta RP, Sharma SK, Vyas GB, Singh V, Ramchandra O. Single-stage posterior-only debridement and transpedicular screw fixation for dorsolumbar tuberculosis: A prospective study of twenty cases. J Orthop Allied Sci 2017; 5: 74
    Search in Google Scholar