Abstract
Introduction and Aims: Socioeconomic deprivation and the HIV epidemic have accounted for the global increase in tuberculosis. Tuberculous spondylitis constitutes 60% of osteoarticular tuberculosis. Progressive kyphosis has been reported with rib grafts in spinal TB. We prospectively evaluated 45 patients treated with fresh frozen anterior cortical allografts for spinal TB.
Method: The mean age was 28.6 years and all patients were HIV negative. The neurological status (Frankel grade) was (A)10, (B)18, (C)17 and the dorsal spine was affected in 37 patients. The kyphosis measured 540 (range 270–740). Following pre-operative nutritional support all patients underwent a radical anterior decompression and the granulation tissue tethering the cord to the apex of the deformity was released. An appropriate length of fresh frozen cortical allograft was positioned by interference fit and stabilised with an anterior rod screw construct. Anti-tuberculosis treatment was prescribed for one year.
Results: Post-operatively, four patients developed pulmonary atelectasis and three patients had superficial wound infections, which resolved with physical therapy and antibiotics respectively. Four patients were excluded due to inadequate follow-up. At 12 months complete neurological recovery occurred in 32 patients, partial in five and no recovery in four patients. There was no radiological evidence of infection or fracture of the allografts. The criteria of Bridwell et al was used to classify the incorporation of allografts. The earliest radiological evidence of fusion and remodelling occurred between 12 and 18 months post-operatively. At the last follow-up (mean 7.8 years, range 6.5–9.2 years) the allografts had incorporated in 33 cases and in eight cases the remodelling was incomplete. Although the incorporation is slow, there were no cases of non-union. The kyphosis measured 220 (range 14–460) at the most recent follow-up.
Conclusion: The weakness of rib grafts is attributed to the unfavourable length, width ratio and the small surface area of contact. Allografts are biological and the stability is enhanced by a large surface area of contact and instrumentation.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
One or more of the authors are receiving or have received material benefits or support from a commercial source.
