Asian Journal of Neurosurgery

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 15  |  Issue : 3  |  Page : 648--652

Outcome analysis of anterior reconstruction with rib grafts in tuberculosis of the thoracic spine


Sudhir Kumar Srivastava1, Nandan A Marathe2, Sunil K Bhosale1, Aditya Raj1, Shaligram Purohit1, Ashraf Shaikh1, Kiran Dhole3 
1 Department of Orthopaedics, Seth G. S. Medical College and KEM Hospital, Mumbai, Maharashtra, India
2 Indian Spinal Injuries Centre, New Delhi, India
3 Department of Orthopaedics, Lokamanya Tilak Medical College and Sion Hospital, Mumbai, Maharashtra, India

Correspondence Address:
Dr. Nandan A Marathe
Saraswati Prasad, Gaul Wada, Vasai (W), Vasai-Virar - 401 201, Maharashtra
India

Introduction: Tricortical iliac bone is the gold standard as an autograft for the reconstruction of the anterior column in tuberculosis (TB) of the thoracic spine. However, the quantity of graft needed is significant. It creates a considerable defect in the pelvic bone, causing graft site complications, including pain, pelvic instability, fractured ilium, herniated muscle, or abdominal contents. To prevent these donor site morbidities, ribs that were removed during the versatile approach were used for anterior reconstruction. The aim of this study was to assess the clinical and radiological results of the reconstruction of the anterior column of the spine with the help of an excised rib during the versatile approach. Subjects and Methods: This retrospective study was undertaken at a tertiary care center with a study duration of 14 years. Between January 2004 and December 2016, 52 patients with thoracic Koch's spine had anterior column reconstructed with multiple rib grafts. A single surgeon performed all operations. Indications for the surgery in these patients were the presence of neurologic deficit (49 patients) and vertebral column instability (3 patients). The preoperative kyphosis angle and visual analog scale (VAS) score were compared with postoperative values using a paired t-test. Results: All patients underwent a minimum follow-up of 18 months and were evaluated clinicoradiologically. Good bony fusion with neurological recovery was achieved in all cases. The VAS score for back pain improved significantly postsurgery. There was one case of graft buckling treated conservatively. Discussion: Appropriate anterior reconstruction forms the cornerstone of successful surgical management of spinal TB. The “Versatile approach” used offers anterior and posterior access in the lateral position. In these patients, we obviated the need for iliac crest graft using multiple segments of the rib for anterior column reconstruction. This meticulous rib grafting technique gives good functional outcome in terms of solid bony fusion. Conclusion: Meticulous rib grafting technique gives 360° bony fusion and good functional outcome in surgery for thoracic spinal TB. It has the advantage of avoiding the complications associated with a tricortical iliac crest graft.


How to cite this article:
Srivastava SK, Marathe NA, Bhosale SK, Raj A, Purohit S, Shaikh A, Dhole K. Outcome analysis of anterior reconstruction with rib grafts in tuberculosis of the thoracic spine.Asian J Neurosurg 2020;15:648-652


How to cite this URL:
Srivastava SK, Marathe NA, Bhosale SK, Raj A, Purohit S, Shaikh A, Dhole K. Outcome analysis of anterior reconstruction with rib grafts in tuberculosis of the thoracic spine. Asian J Neurosurg [serial online] 2020 [cited 2020 Oct 27 ];15:648-652
Available from: https://www.asianjns.org/article.asp?issn=1793-5482;year=2020;volume=15;issue=3;spage=648;epage=652;aulast=Srivastava;type=0