TRANSPEDICULAR FIXATION IN SURGICAL TREATMENT OF TUBERCULOUS SPONDYLITIS AND CHRONIC HEMATOGENIC OSTEOMYELITIS OF THE SPINE

Abstract

Objective. To study the effect of transpedicular fixation (TPF) on treatment results in tuberculous spondylitis and chronic hematogenic osteomyelitis of the spine. Material and Methods. A total of 99 patients aged 18 to 72 were operated on for tuberculous spondylitis and hematogenic osteomyelitis involving Th1 to S1 vertebral bodies. The patients were divided into three groups based on the type of the surgical intervention: group I included 37 patients who underwent radical reconstructive surgery without posterior fixation; group II included 24 patients with radical reconstructive surgery complemented with semi-rigid fixation; and group III – 33 patients with radical reconstructive surgery combined with TPF. The treatment efficacy was estimated on the basis of kyphotic deformity dynamics, autograft length, neurological status, pain syndrome, anterior fusion rate, and nature of complications. Results. Treatment results were assessed as good, satisfactory and unsatisfactory in 18 (48.6 %), 4 (10.8 %) and 15 (40.5 %) patients of group I, respectively. In group II the estimates were 15 (55.5 %), 8 (29.6 %) and 4 (14,8 %), and in group III – 32 (91,4 %), 3 (8,6 %) and 0 (0,0 %), respectively. Conclusion. The use of transpedicular fixation in addition to radical reconstructive surgery in tuberculous spondylitis and hematogenic osteomyelitis provides the improvement of treatment results including prevention of graft height decrease and kyphosis correction loss, reduction of postoperative complications, and intensification of patient’ rehabilitation.