title: Lateral Extracavitary Approach Versus Posterior Extensive Circumferential Decompression in the Treatment of Complicated Thoracic and Lumbar Tuberculous Spondylitis.
abstract: OBJECTIVE
  The aim of this study was to retrospectively evaluate 45 patients operated upon either by posterior extensive circumferential decompression (PECD) or by the lateral extracavitary (LEC) technique and compare the clinical, radiologic, laboratory, and functional outcomes.
  
  
  BACKGROUND
  The debate continues on the best decompression-fusion technique for treating complicated spinal tuberculosis. In recent times, the advantages of combined surgery have been successfully achieved using the 1-stage salvage technique, with enough accessibility to all 3 spinal columns.
  
  
  METHODS
  From January 2011 to December 2013, 51 patients with complicated spinal tuberculous were surgically treated at our department. After gaining the approval of the local ethics committee, 45 patients and their records were available for evaluation. The patients were divided into 2 groups. Group I included 23 patients treated with PECD and group II included 22 patients treated with LEC. Two authors and an independent observer performed the final clinical assessment by means of clinical examination and by using the Visual Analog Scale and Oswestery Disability Index for determining pain, disability, and quality of life. The radiographs were reviewed independently by 3 authors and a radiologist for fusion, kyphotic angle, and angle loss rate. Neurological assessment using the American Spinal Injury Association motor index was performed by 2 authors and a neurologist independently.
  
  
  RESULTS
  The mean follow-up period was 36±5.5 months. In all patients, local symptoms were relieved significantly postoperatively. There were no major complications in this series. Three patients contracted superficial wound infection and 2 developed intercostal neuralgia. Both complications resolved uneventfully and did not influence the outcome. Solid interbody fusion was diagnosed in 43 cases (95.6%). Deformity correction and neurological recovery were significantly improved in both groups (P<0.001). PECD showed better results than LEC.
  
  
  CONCLUSIONS
  Both procedures attained good results for maintained deformity correction, bony fusion, spinal cord decompression, and neurological improvement in complicated tuberculous spondylitis. However, PECD may be superior to LEC.
authors.affiliation: *Department of Orthopedic Surgery and Traumatology †Minia University Spine Unit (MUSU), Minia University Hospital, Minia University, El-Minia University, El-Minia, Egypt.
authors.forename: Khaled
authors.initials: K
authors.lastname: Omran
authors.forename: Ahmed S
authors.initials: AS
authors.lastname: Abdel-Fattah
authors.forename: Ahmed M A
authors.initials: AMA
authors.lastname: Othman
authors.forename: Ahmed O
authors.initials: AO
authors.lastname: Youssef
authors.forename: Amr
authors.initials: A
authors.lastname: Solimen
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: ElRefai
authors.forename: Ahmed N
authors.initials: AN
authors.lastname: Saleh
authors.forename: Mohammed
authors.initials: M
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D000328:Adult; D019299:Decompression, Surgical; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000601:surgery; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011182:Postoperative Care; D013166:Spondylitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014399:Tuberculosis, Spinal / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery*; D064232:Visual Analog Scale; D055815:Young Adult