Surgical Treatment of Thoracolumbar Pott’s Disease at Niamey National Hospital (HNN) about 34 Cases

Haboubacar Chaibou Sode; Assoumane Issa Ibrahim; Brice Sawa; Rachida ibn Aboubacar; O. Issoufou Hamma; Aminat Kelani

doi:10.59573/emsj.7(4).2023.7

Авторы

Haboubacar Chaibou Sode
Assoumane Issa Ibrahim
Brice Sawa
Rachida ibn Aboubacar
O. Issoufou Hamma
Aminat Kelani

DOI:

https://doi.org/10.59573/emsj.7(4).2023.7

Ключевые слова:

Pott's disease, thoraco-lumbar junction, surgery, anterior approach, Niamey

Аннотация

Pott's disease or tuberculous spondylodiscitis is one of the most serious forms of osteoarticular tuberculosis, responsible for spinal cord compression and/or "cauda equina" syndrome due to granulomatous and/or abscessed tuberculous epiduritis. Surgery therefore plays a key role in the management of this pathology, although surgical techniques vary widely from one author to another and from one department to another.

The aim of our work is to describe the different techniques used in our department during the study period, and to evaluate the results.

This is a prospective study concerning 34 cases of dorsolumbar and lumbar Pott's disease collised in the neurosurgery department of Niamey National Hospital from January 2020 to December 2021.

Analysis of our results found 26 men and 8 women with a sex ratio of 3.25; the extreme ages were 11 and 76 years and the mean age was 40.53 years. 20 patients presented with dorsal cord compression syndrome, 12 with cauda equina syndrome, 6 with conus medullaris syndrome and 2 with multifocal localization.

CT was performed in all patients and MRI in only one. All patients were treated with antibacillary chemotherapy. In 16 patients (47.06%), a posterolateral approach consisting of hemilaminectomy, pediculotomy and unilateral arthrectomy was used; in 9 patients (26.47%) a posterior approach consisting of fenestration; and laminectomy in 4 patients (11.76%). An anterior approach in 3 patients (8.82%), consisting of a corpectomy and an antero-lateral approach (pediculo-artrectomy-corpectomy) in 2 patients (5.89%). All our patients underwent debridement, evacuation of residual pus and sequestrectomy. Out of the debridement filling of the defect was performed in 23 cases with a spinous graft, 2 with fibula, 2 with a rib graft and one with an iliac bone graft.

At 4 months post-surgery, radicular signs had completely disappeared in all patients, and sensory-motor deficit had improved in 30 patients (88.23%). There was a reduction in kyphosis in all patients who had benefited from an anterior approach, compared with 41.38 % who had undergone a posterior approach.

Библиографические ссылки

Alici, E., Ak?ali, ?., Tatari, H., & G?nal, ?. (2001). Effect of preoperative chemotherapy on the outcome of surgical treatment of vertebral tuberculosis: retrospective analysis of 434 cases. Archives of orthopaedic and trauma surgery, 121, 65-66.

Alliez, J.R., Balan, C., Diallo, O., & Alliez, B. (2012). Pott’s disease and pott’s paraplegia. African Journal of Neurological Sciences, 25, 50-9.

Barriere, V., Gepner, P., Bricaire, F., Bl?try, O., & Caumes, E. (1999). Aspects actuels de la tuberculose vert?brale ? propos de 16 observations. Annales de m?decine interne (Paris), 150(5), 363-369.

Benli, I., Acaro?lu, E., Akalin, S., Ki?, M., Duman, E., & ?n, A. (2003). Anterior radical debridement and anterior instrumentation in tuberculosis spondylitis. European Spine Journal, 12, 224-234.

Bernard, L. & Peronne, C. (1997). La tuberculose ost?o – articulaire aujourd’hui. La presse m?dicale, 21(7).

Calderone, R. R., & Larsen, J. M. (1996). Overview and classification of spinal infections. Orthopedic Clinics of North America, 27(1), 1-8.

Camara, P., Margery, J., B?-Fall, K., Diop, A., Lefevre, N., & Chevalier, B. (2006). Le mal de Pott chez l'adulte ? l'H?pital Principal de Dakar. Revue de pneumologie clinique (Paris), 62(4), 258-259.

Chen, Y. C., Chang, M. C., Wang, S. T., Yu, W. K., Liu, C. L., & Chen, T. H. (2003). One-stage posterior surgery for treatment of advanced spinal tuberculosis. Journal of the Chinese Medical Association: JCMA, 66(7), 411-417.

Dharmalingam, M. (2004). Tuberculosis of the spine-the Sabah experience. Epidemiologic, treatment and result. Tuberculosis, 84, 24-8.

Duva Ferrier, R., De Korvin, B., Le Grand, E., Maison, A., & Meadeb, J. (1993). Imagerie diagnostique de la spondylodiscite infectieuse. Encycl. M?d. Chir (Paris. France) - Editions techniques Radiodiagnostic. Neuroradiologie. Appareil locomoteur, 31-335-A-10.

Feron, J. M. (1996). Les voies d'abord du rachis dorso-lombaire. Cahiers d'enseignement de la SOFCOT, 55, 211-220.

Ghadouane, M., Elmansari, O., Bousalmame, N., Lezrek, K., Aouam, H., & Moulay, I. (1996). Place de la chirurgie dans le traitement du mal de Pott de l’adulte. A propos de 29 cas. Rev Chir Orthop Reparatrice Appar Mot, 82, 620-8.

Govender, S., & Parbhoo, A. H. (1999). Support of the anterior column with allografts in tuberculosis of the spine. The Journal of Bone & Joint Surgery British Volume, 81(1), 106-109.

Jin, D., Qu, D., Chen, J., & Zhang, H. (2004). One-stage anterior interbody autografting and instrumentation in primary surgical management of thoracolumbar spinal tuberculosis. European Spine Journal, 13, 114-121.

Journeau, P., Koura, A., Mary, P., Padovani, J. P., & Touzet, P. (1999). Paraplegie d'origine pottique chez l'enfant: Mecanismes et strategies therapeutiques: a propos de 6 cas. Revue de chirurgie orthop?dique et r?paratrice de l'appareil moteur, 85(2), 117-124.

Le Breton, C., Carette, M. F., Amram, S., WALLAYS, C., DA SILVA, F., & JUIMO, A. (1993). Mal de Pott: int?r?t de l'imagerie par r?sonance magn?tique (IRM). Revue d'imagerie m?dicale, 5(8), 545-551.

Loembe, P. M. (1995). Medical-surgical treatment of progressive tuberculous (Pott's) paraplegia in Gabon. Spinal Cord, 33(10), 579-584.

Loembe, P. M., Mwanyombet-Ompounga, L., Assengone-Zeh, Y., & Kengue-Lechiombeka, P. R. (2000). Chirurgie ant?ro-lat?rale pr?coce du rachis cervical inf?rieur dans la spondylodiscite tuberculeuse avec troubles neurologiques chez l'adulte: Notre exp?rience au Gabon. Neuro-chirurgie (Paris), 46(6), 541-548.

Louis, R., Conty, C. R., & Pouye, I. (1970). Chirurgie du mal de Pott avec correction des gibbosit?s. J Chir (Paris), 99(4), 401-16.

Maftah, M., Lmejjati, M., Mansouri, A., El Abbadi, N., & Bellakhdar, F. (2001). Mal de Pott ? propos de 320 cas. M?decine du Maghreb, 90, 19-22.

Malan, H. M. (2002). Evolution de la prise en charge chirurgicale de la spondylodiscite tuberculeuse. A propos de 15 cas ? l’h?pital National de Niamey : 2002 Th?se n°45.

Mehta, J. S. (2001). Tuberculosis of the thoracic spine: a classification based on the selection of surgical strategies. The Journal of Bone & Joint Surgery British Volume, 83(6), 859-863.

Moon, M. S., Rhee, S. K., & Kang, Y. K. (1986). Harrington rods in treatment of active spinal tuberculosis with kyphosis. J Western Pacif Orthop Assoc, 23, 53-8.

Ozdemir, H. M., Us, A. K., & ?g?n, T. (2003). The role of anterior spinal instrumentation and allograft fibula for the treatment of pott disease. Spine, 28(5), 474-479.

Pertuiset, E. (1998). Tuberculose vert?brale de l'adulte. Encycl M?d Chir (Elsevier, Paris), Appareil locomoteur, 15-852-A-10.

Ramare, S., Benazet, J.P., Barraba, D., Robin, H., Saillant, G.,& Bourgeois, P. (1998). Traitement chirurgical du mal de Pott de l’adulte dans la phase aigu?. www.sofcot.com.fr/FREE/bibliographie/communications/1998/art37.html

Rezai, A. R., Lee, M., Cooper, P. R., Errico, T. J., & Koslow, M. (1995). Modern Management of Spinal Tuberculosis Clinical Study: 87. Neurosurgery, 36(1), 87-98.

Sanoussi, S., Sani, R., Djomo, T. M., & Bawa, M. (2005). Prise en charge du pott lombaire par abord postero-lateral: A propos de 17 cas ? l'h?pital national de Niamey. M?decine d'Afrique Noire, 52(5), 261-266.

Takongmo, S., Nko’o Amvene, S., Jui Mo Ag. et al. (1993). Probl?mes des diagnostics ? propos de 2 cas cliniques de mal de pott lombaire. M?decine tropicale, 53(4).

Yilboudo, J., Da, S. C., Nacoulma, S. I., & Bandre, E. (2002). Spondylodiscite tuberculeuse avec troubles neurologiques: R?sultats du traitement chirurgical. Med Trop (Mars), 62(1), 39-46.

Yilmaz, C., Selek, H. Y., G?rkan, I., Erdemli, B., & Korkusuz, Z. (1999). Anterior instrumentation for the treatment of spinal tuberculosis. JBJS, 81(9), 1261-7.