COMPARISON BETWEEN MODIFIED HONG KONG AND MODIFIED KALAFONG OPERATIONS IN TB SPINE PATIENTS- A CROSS SECTIONAL STUDY IN CMH RAWALPINDI

Muhammad Shoaib Khan, Waseem Afzal, Abdul Qadir Khan, Shahzad Inam, Asad Ullah Mehmood, MK Safdar, M A Qureshi

Abstract


Background: Spine tuberculosis is common in Pakistan and this needs expert treatment to decrease morbidity. The objective of this study was to compare Modified Kalafong (MKF) and Modified Hong Kong (MHK) operations for spinal TB patients regarding neurological recovery and deformity correction.

Material and Methods: This cross sectional study was conducted at Combined Military Hospital (CMH), Rawalpindi, Pakistan, on data from February 2012 to November 2020. According to the selection criteria and availability of data, 70 patients out of 90 consecutive patients handled surgically by MKF or MHK Operations were chosen for this research. Frankel grade system, Cobb’s technique and Bridwell’s criteria were used for assessment of results.

Results: There were thirty-one cases of MHK and thirty-nine cases of MKF patients. Age, Neurological recovery, and Numbers of Vertebrae involved with TB were comparable across the two groups. In the MHK, the mean operating time was 6.12 hours, whereas in the MKF, it was 5.37 hours. When compared to the MKF, where the mean blood loss was 0.921 L, the MHK had a greater mean blood loss of 1.139 L. Deformity correction with MHK was 79.467 % against 58.40% via MKF, which was statistically significant (P 0.001). The MHK group had a much shorter mean time to fusion (4.56 months) than the MKF group (6.74 months), which is significant (P 0.05) statistically.

Conclusion: Our study revealed significant differences between MHK and MKF spinal tuberculosis surgeries in terms of fusion time, blood loss and deformity correction.


Keywords


Spine; Surgery; Tuberculosis; Neurology; Blood; curettage; debridement.

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References


WHO Report 2009 Global TB control: www.who.int/GlobalAtlas/predefined_reports/tb/pdf-Files/ pak-pdf

Fancourt GJ, Ebden P, Garner P. Bone tuberculosis, results and experience in Leicestershire. Br J Dis Chest 1986;80:265-272. https://doi.org/10.1016/0007-0971(86)90062-8

Davies PD, Humphries MJ, Byfed SP. Bone and joint tuberculosis. A survey of notifications in England and Wales. J Bone J Surg Br 1984;66:326-330. https://doi.org/10.1302/0301-620X.66B3.6427232

Benli IT, Acaroğlu E, Akalin S, Kiş M, Duman E, Un A. Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. Eur Spine J 2003;12:224-234. https://doi.org/10.1007/s00586-002-0403-0

Global health:Tuberculosis overview-Kaiser Global Health.global health.off.org/Diseases/T.B.aspx

Rezai AR, Lee M, Cooper PR, Errico TJ, Koslow M. Modern management of spinal tuberculosis. Neurosurgery 1995;36(1):87-97. https://doi.org/10.1227/00006123-199501000-00011

Luk KD. Tuberculosis of the spine in the new millennium. Eur Spine J 1999;8(5):338-345. https://doi.org/10.1007/s005860050185

Moon MS. Tuberculosis of the spine. Controversies and a new challenge. Spine (Phila Pa 1976) 1997;22(15):1791-1797. https://doi.org/10.1097/00007632-199708010-00022

Hodgson AR, Stock FE, Fang HS, Ong GB. Anterior spinal fusion. The operative approach and pathological findings in 412 patients with Pott's disease of the spine. Br J Surg 1960;48:172-178. https://doi.org/10.1002/bjs.18004820819

A 10-year assessment of a controlled trial comparing debridement and anterior spinal fusion in the management of tuberculosis of the spine in patients on standard chemotherapy in Hong Kong. Eighth Report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone J Surg Br 1982;64(4):393-398. https://doi.org/10.1302/0301-620X.64B4.7047536

Thirteenth Report Of The Medical Research Council Working Party On Tuberculosis Of The Spine. A 15-year assessment of controlled trials of the management of tuberculosis of the spine in Korea and Hong Kong. J Bone J Surg Br 1998;80:456-62. https://doi.org/10.1302/0301-620X.80B3.0800456

Erturer E, Tezer M, Aydogan M, Mirzanli C, Ozturk I. The results of simultaneous posterior-anterior-posterior surgery in multilevel tuberculosis spondylitis associated with severe kyphosis. Eur Spine J 2010;19(12):2209-2215. https://doi.org/10.1007/s00586-010-1481-z

Christodoulou AG, Givissis P, Karataglis D, Symeonidis PD, Pournaras J. Treatment of tuberculous spondylitis with anterior stabilization and titanium cage. Clin Orthop Relat Res 2006;444:60-5. https://doi.org/10.1097/01.blo.0000201175.87635.28

Benli IT, Kaya A, Acaroğlu E. Anterior instrumentation in tuberculous spondylitis: Is it effective and safe? Clin Orthop Relat Res 2007;460:108-116. https://doi.org/10.1097/BLO.0b013e318065b70d

Lim JK, Kim SM, Jo DJ, Lee TO. Anterior interbody grafting and instrumentation for advanced spondylodiscitis. J Korean Neurosurg Soc 2008;43:5-10. https://doi.org/10.3340/jkns.2008.43.1.5

Bridwell KH, Lenke LG, McEnery KW, Baldus C, Blanke K. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976) 1995;20:1410-1418. https://doi.org/10.1097/00007632-199506020-00014

Chen WJ, Wu CC, Jung CH, Chen LH, Niu CC, Lai PL. Combined anterior and posterior surgeries in the treatment of spinal tuberculous spondylitis. Clin Orthop Relat Res 2002;398:50-59. https://doi.org/10.1097/00003086-200205000-00008

Sahoo MM, Mahapatra SK, Sethi GC, Dash SK. Posterior‑only approach surgery for fixation and decompression of thoracolumbar spinal tuberculosis: A retrospective study. J Spinal Disord Tech 2012;25:217-223. https://doi.org/10.1097/BSD.0b013e31826a088e

Luo C, Wang X, Wu P, Ge L, Zhang H, Hu J. Single‑stage transpedicular decompression, debridement, posterior instrumentation, and fusion for thoracic tuberculosis with kyphosis and spinal cord compression in aged individuals. Spine J 2016;16:154-162. https://doi.org/10.1016/j.spinee.2013.11.014

Oga M, Arizono T, Takasita M, Sugioka Y. Evaluation of the risk of instrumentation as a foreign body in spinal tuberculosis. Clinical and biologic study. Spine (Phila Pa 1976) 1993;18:1890-1894. https://doi.org/10.1097/00007632-199310000-00028

Hodgson AR, Stock FE. The Classic: Anterior spinal fusion: A preliminary communication on the radical treatment of Pott's disease and Pott's paraplegia. 1956. Clin Orthop Relat Res 2006;44:10-15. https://doi.org/10.1097/01.blo.0000203456.67016.b7

Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg Am 1989;71:1314-1323. https://doi.org/10.2106/00004623-198971090-00006

Louw JA. Spinal tuberculosis with neurological deficit. Treatment with anterior vascularised rib grafts, posterior osteotomies and fusion. J Bone Joint Surg Br 1990;72:686-693. https://doi.org/10.1302/0301-620X.72B4.2380228

Yilmaz C, Selek HY, Gürkan I, Erdemli B, Korkusuz Z. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg Am 1999;81:1261-1267. https://doi.org/10.2106/00004623-199909000-00007

Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of the dorso-lumbar spine. Spinal Cord 2001;39:429-436. https://doi.org/10.1038/sj.sc.3101185

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;90:1477-1481. https://doi.org/10.1302/0301-620X.90B11.20972

Ozdemir HM, Us AK, Oğün T. The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine (Phila Pa 1976) 2003;28:474-479. https://doi.org/10.1097/01.BRS.0000048666.17934.17

Ma YZ, Cui X, Li HW, Chen X, Cai XJ, Bai YB. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop 2012;36:299-305. https://doi.org/10.1007/s00264-011-1390-8

Kemp HB, Jackson JW, Jeremiah JD, Cook J. Anterior fusion of the spine for infective lesions in adults. J Bone Joint Surg Br 1973;55:715-734. https://doi.org/10.1302/0301-620X.55B4.715

Garg B, Kandwal P, Nagaraja UB, Goswami A, Jayaswal A. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop 2012;46:165-170. https://doi.org/10.4103/0019-5413.93682.




DOI: https://doi.org/10.46903/gjms/20.04.1225

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