Surgical Treatment Spine Tuberculosis by Decompression and Posterior Stabilization via Transpedicular Approach: a Retrospective Study

Abstract

Clinical intervention has a central role in the outcome of spondylitis tuberculosis cases. Surgical procedures indicate to prevent neurological collapse, preservation of stability, and early mobilization. The study aims to analyze the outcome of surgical intervention in spinal tuberculosis by using a transpedicular approach. This research was a retrospective study on the Department of Orthopaedics and Traumatology in Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, during 2016–2018. There were 64 subjects in this study; 35 were male, and 29 were female, ages ranged 21–60 years with a follow-up period of 12 months to 18 months. A more common site of tubercular lesion was at the thoracal lesion (44%). In this research, the patients were preoperatively categorized by the American Spinal Injury Association (ASIA) Impairment Assessment. Among them four were ASIA-A, 10 were ASIA-B, 30 were ASIA-C, 15 were ASIA-D, and five were ASIA-E. After the operative procedure, two patients were ASIA-B, five patients were ASIA-C, 17 patients were ASIA-D, and 40 were ASIA-E. Maximum patients (62%) had bony fusion grade 1. Greater than 80% of subjects had a satisfactory result. In conclusion, posterior decompression and preservation of stability with transpedicular fusion are an excellent surgical way of posterior lumbar spinal tuberculosis treatment.

TINDAKAN OPERASI DEKOMPRESI DAN STABILISASI POSTERIOR MELALUI PENDEKATAN TRANSPEDIKULAR PADA TUBERKULOSIS TULANG BELAKANG: STUDI RETROSPEKTIF

Tindakan medis berperan penting pada manajemen akhir kasus tuberkulosis tulang belakang. Prosedur operasi dilakukan untuk mencegah perburukan defisit neurologis, menjaga kestabilan tulang belakang, dan mobilisasi dini. Tujuan penelitian ini adalah menganalisis luaran hasil tindakan operatif pada tuberkulosis tulang belakang dengan pendekatan transpedikular. Penelitian ini merupakan studi retrospektif di Departemen Orthopaedi dan Traumatologi RSUP Dr. Hasan Sadikin, Bandung, Indonesia, periode tahun 2016–2018. Terdapat 64 subjek dalam penelitian ini yang terdiri atas 35 laki-laki dan 29 perempuan, serta usia berkisar 21–60 tahun dengan masa tindak lanjut 12–18 bulan. Pada penelitian ini, lesi tuberkuler paling banyak terjadi di regio torakal (44%). Subjek penelitian dikategorikan menurut Impairment Assessment dari American Spinal Injury Association (ASIA). Preoperatif terdapat empat pasien ASIA-A, 10 pasien ASIA-B, 30 pasien ASIA-C, 15 pasien ASIA-D, dan lima pasien ASIA-E. Setelah tindakan operasi terdapat dua pasien ASIA-B, lima pasien ASIA-C, 17 pasien ASIA-D, dan 40 pasien ASIA-E. Mayoritas pasien memiliki fusi tulang grad 1 (62%). Lebih dari 80% subjek penelitian menyatakan puas setelah operasi dilakukan. Simpulan, tindakan operatif dekompresi dan stabilisasi dengan fusi transpedikular merupakan metode yang unggul dalam manajemen tuberkulosis tulang belakang.