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Sekhar Sethy S, Mittal S, Goyal N, Sudhakar PV, Verma V, Jain A, Verma A, Vathulya M, Sarkar B, Kandwal P. Healing Assessment of Spinal Tuberculosis: A Systematic Review. World Neurosurg 2024; 185:141-148. [PMID: 38367856 DOI: 10.1016/j.wneu.2024.02.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/09/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.
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Affiliation(s)
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - P Venkata Sudhakar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vishal Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aakash Jain
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Aman Verma
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India.
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Ifthekar S, Ahuja K, Mittal S, Yadav G, Chaturvedi J, Sarkar B, Kandwal P. Outcomes of Dorsolumbar and Lumbar Spinal Tuberculosis Treated by Minimally Invasive and Open Techniques: A Prospective Comparative Study. Indian J Orthop 2024; 58:558-566. [PMID: 38694702 PMCID: PMC11058730 DOI: 10.1007/s43465-024-01123-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 02/11/2024] [Indexed: 05/04/2024]
Abstract
Purpose of Study To compare the outcomes of minimally invasive and open techniques in the surgical management of dorsolumbar and lumbar spinal tuberculosis (STB). Methods Skeletally mature patients with active STB involving thoracolumbar and lumbar region confirmed by radiology (X-ray, MRI) and histopathological examination were included. Healed and mechanically stable STB, patients having severe hepatic and renal impairment, coexisting spinal conditions such as ankylosing spondylitis and rheumatoid arthritis, and patients unwilling to participate were excluded from the study. The patients were divided in to two groups, group A consisted of patients treated by MIS techniques and group B consisted of patients treated by open techniques. All the patients had a minimum follow-up of 24 months. Results A total of 42 patients were included in the study. MIS techniques were used in 18 patients and open techniques were used in 24 patients. On comparison between the two groups, blood loss (234 ml vs 742 ml), and immediate post-operative VAS score (5.26 vs 7.08) were significantly better in group A, whereas kyphotic correction (16° vs 33.25°) was significantly better in group B. Rest of the parameters such as duration of surgery, VAS score, ODI score and number of instrumented levels did not show significant difference between the two groups. Conclusion MIS stabilization when compared to open techniques is associated with significant improvement in immediate post-operative VAS scores. The MIS approaches at 2-year follow-up have functional results similar to open techniques. MIS is inferior to open techniques in kyphosis correction and may be associated with complications.
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Affiliation(s)
- Syed Ifthekar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- Department of Orthopaedics, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
- BLK Max Speciality Hospital, Delhi, India
| | - Gagandeep Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Jiitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Bhaskar Sarkar
- Department of Trauma Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand India
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Ahuja K, Ifthekar S, Mittal S, Yadav G, Venkata Sudhakar P, Sharma P, Venkata Subbaih A, Kandwal P. Role of Diffusion Tensor Imaging in neurological prognostication in Spinal Tuberculosis – A prospective pilot study. Eur J Radiol 2022; 157:110530. [DOI: 10.1016/j.ejrad.2022.110530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/16/2022] [Accepted: 09/16/2022] [Indexed: 11/03/2022]
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Ahuja K, Kandwal P, Ifthekar S, Sudhakar PV, Nene A, Basu S, Shetty AP, Acharya S, Chhabra HS, Jayaswal A. Development of Tuberculosis Spine Instability Score (TSIS): An Evidence-Based and Expert Consensus-Based Content Validation Study Among Spine Surgeons. Spine (Phila Pa 1976) 2022; 47:242-251. [PMID: 34269760 DOI: 10.1097/brs.0000000000004173] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An expert-panel consensus-based content validation and case-based clinical validation study. OBJECTIVE To develop a novel scoring system for diagnosing instability in tuberculosis (TB) spine using an expert-panel consensus followed by clinical validation for validating the content. SUMMARY OF BACKGROUND DATA Currently, diagnosis of instability is primarily experience-based which may lead to considerable variability and misdiagnosis in the hands of a relatively in-experienced spine surgeon. Considering the potential complications this entity entails, a universally accepted scoring criteria is very important for accurate and uniform diagnosis of instability in TB spine. METHODS The development of TB spine instability score (TSIS) followed a two-step process, one designing the instrument and the other obtaining judgemental evidence. For judgemental evidence a panel of experts was appointed to make appropriate modifications and content validation for finalizing the scoring instrument. This score was applied on 30 patients of TB spine and receiver operating characteristic (ROC) curves were drawn for sensitivity and specificity analysis. RESULTS The comprehensive scoring criteria to diagnose instability in TB spine was approved after three rounds of expert panel discussions with an index of content validation more than 0.75 after final round of panel discussion. On case-based validation after plotting ROC curves, sensitivity and specificity for diagnosing stable and potentially unstable lesions at a cut-off score of 6 was 92.9% and 86.8% respectively whereas for diagnosing potentially unstable and unstable lesions at a cut-off score of 10 was 94.3% and 81.9%, respectively. CONCLUSION TSIS is a comprehensive scoring system integrating demographic, anatomical, clinical, and radiological factors aimed at diagnosing instability in TB spine. The classification determines indications for surgical stabilization in patients with TB spine, with no or little neurological deficit.Level of Evidence: 4.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Syed Ifthekar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pudipetti Venkata Sudhakar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Abhay Nene
- Department of Spine, Wockhardt Hospital, Mumbai, India
- Department of Orthopaedics, Hinduja Healthcare Surgical, Mumbai, India
- Department of Orthopaedic Surgery, Lilavati Hospital & Research Centre, Mumbai, India
- Department of Orthopaedics, Breach Candy Hospital Trust, Mumbai, India
- Department of Orthopedics, Wadia Children's Hospital, Mumbai, India
| | - Saumyajit Basu
- Department of Spine Surgery, Kothari Medical Center, Kolkata, India
- Department of Spine Surgery, Park Clinic, Kolkata, India
| | | | - Shankar Acharya
- Department of Spine Surgery, Sir Gangaram Hospital, New Delhi, India
| | | | - Arvind Jayaswal
- Department of Orthopaedics, Primus Superspeciality Hospital, New Delhi, India
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Goyal N, Ahuja K, Yadav G, Gupta T, Ifthekar S, Kandwal P. PEEK vs Titanium Cage for Anterior Column Reconstruction in Active Spinal Tuberculosis: A Comparative Study. Neurol India 2021; 69:966-972. [PMID: 34507423 DOI: 10.4103/0028-3886.325384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Posterolateral decompression and debridement in patients with TB spine led to defect in the anterior column which makes the spinal column unstable, thus making anterior column reconstruction an important step in surgical management. Objective Through the study, authors sought to answer the following questions: 1) What are the differences in clinical outcomes between patients with TB spine undergoing anterior column reconstruction using titanium mesh cage versus PEEK cage? 2) What are the differences in radiological outcomes between these two groups of patients? Methods This is a retrospective comparative study including patients with TB spine undergoing surgical management. The included subjects were divided into groups A and B depending on the implantation of PEEK or titanium mesh cage respectively for anterior column reconstruction. Outcome criteria analyzed included clinical criteria like VAS and ODI scores, radiological criteria like kyphosis correction, loss of kyphosis at follow-up, cage subsidence, and bony fusion on a 2D CT scan. Results The study population included 14 patients in Group A and 15 patients in Group B. Improvement in VAS and ODI scores was comparable between groups. There was no significant difference in radiological outcome measures between the two groups, however, two patients from group B showed implant-related complications needing revision. All patients showed good bony fusion at the final follow-up. Conclusion PEEK and titanium cages have comparable clinico-radiological outcomes for anterior column reconstruction in patients with active TB spine. Its advantages for being radiolucent and its ease of use may make it a choice of implant.
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Affiliation(s)
- Nikhil Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustubh Ahuja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Gagandeep Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Tushar Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Syed Ifthekar
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pankaj Kandwal
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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