One-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged

Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up

BACKGROUND

Paravertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement (BED) to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up.

METHODS

We conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess who underwent BED combined with local antituberculosis drugs (BED + LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges) of 59.0(16.5) years were included in the study. All patients received the BED + LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol). All relevant indicators were meticulously recorded and analyzed.

RESULTS

The surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05).

CONCLUSIONS

The application of BED + LAD in the treatment of thoracic tuberculosis and paravertebral abscess proved to be a safe, effective, and feasible approach.

Effectiveness and safety analysis of titanium mesh grafting versus bone grafting in the treatment of spinal Tuberculosis: a systematic review and meta-analysis

BACKGROUND

To systematically assess the safety and effectiveness of titanium mesh grafting compared with bone grafting in the treatment of spinal tuberculosis.

METHODS

Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched from their inception until April 2023. The outcome indicators for patients treated with titanium mesh grafting or bone grafting for spinal tuberculosis include surgical duration, intraoperative blood loss, graft fusion time, American Spinal Injury Association (ASIA) Spinal Cord Injury Grade E assessment, VAS score, lumbar pain score, post-graft kyphotic angle, and postoperative complications. The Newcastle-Ottawa Scale (NOS) and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach were used for quality assessment and evidence grading of clinical studies. Funnel plots and Begg's test were employed for bias assessment.

RESULTS

A total of 8 studies were finally included, comprising 523 patients, with 267 cases of titanium mesh fixation and 256 cases of bone grafting. The meta-analysis showed no significant statistical differences in surgical duration (Weighted Mean Difference (WMD) = -7.20, 95% Confidence Interval (CI): -28.06 to 13.67, P = 0.499), intraoperative blood loss (WMD = 16.22, 95% CI: -40.62 to 73.06, P = 0.576), graft fusion time (WMD = 0.97, 95% CI: -0.88 to 2.81, P = 0.304), ASIA Spinal Cord Injury Grade E assessment (Relative Risk (RR) = 1.03, 95% CI: 0.97 to 1.09, P = 0.346), and overall complications (RR = 0.87, 95% CI: 0.49 to 1.55, P = 0.643). Differences in VAS score, ODI lumbar pain score, and post-graft kyphotic angle between the titanium mesh grafting group and the bone grafting group were not significant within the 95% CI range. The rate of postoperative implant subsidence was slightly lower in bone grafting than in titanium mesh grafting (RR = 9.30, 95% CI: 1.05 to 82.22, P = 0.045).

CONCLUSIONS

Both bone grafting and titanium mesh grafting are effective and safe for the surgery, with no significant statistical differences in the results. Considering the limitations of the present study, large-scale randomized controlled trials are warranted to further verify the reliability of this finding.

Posterior-only debridement, bone fusion, single-segment versus short-segment instrumentation for mono-segmental lumbar or lumbosacral pyogenic vertebral osteomyelitis: minimum five year follow-up outcomes

Background

Pyogenic vertebral osteomyelitis (PVO), which is a potentially life-threatening condition and is associated with significant morbidity and mortality, is a cause of back pain that can lead to neurologic deficits if not diagnosed in time and effectively treated. The objective of this study is to compare the efficacy of posterior single-segment and short-segment fixation combined with one-stage posterior debridement and fusion for the treatment of mono-segmental lumbar or lumbosacral PVO.

Methods

Charts of all patients with mono-segmental lumbar or lumbosacral PVO were treated by single-stage posterior debridement, bone graft fusion, and pedicle screw fixation from April 2012 to January 2016. All patients were divided into two groups: sinlge-segment fixation (Group A, n = 31) and short-segment fixation (Group B, n = 36). These patients were followed up for a minimum of five years. The clinical efficacy was evaluated and compared on average operation time, blood loss, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), neurological function recovery and local lordotic angle.

Results

All 67 patients were completely cured during the follow-up. All patients had significant improvement of neurological condition and pain relief at the final follow-up. The VAS was 7.1 ± 0.7 in group A and 7.2 ± 0.6 in group B pre-operatively, which decreased to 2.1 ± 0.6 and 2.0 ± 0.7, respectively, at three months after surgery, then reduced to 0.4 ± 0.5 and 0.5 ± 0.5, respectively, at the final follow-up. ESR, CRP returned to normal limits in all patients 3 months after surgery. The mean blood loss and operation time in group A were less than that in group B (P < 0.05). The local lordotic angle in group A was increased from preoperative − 1.7 ± 7.9° to postoperative 5.8 ± 7.1°, with angle loss of 1.5 ± 0.8° at the final follow-up, respectively (P < 0.05). The local lordotic angle in group B was increased from preoperative − 1.6 ± 7.8° to postoperative 13.5 ± 6.2°, with angle loss of 1.3 ± 0.8° at the final follow-up, respectively (P < 0.05). In the mean postoperative local lordotic angle, there was significant difference between the two groups at the time of immediate postoperative period or the final follow-up (P < 0.05).

Conclusion

Posterior-only debridement, interbody graft using titanium mesh cage, posterior single-segment instrumentation and fusion represent a safe and effective treatment option for selected patients with mono-segmental lumbar and lumbosacral PVO. This approach may preserve more lumbar normal motor units with less blood loss and operation time when compared with that of short-segment fixation. But short-segment fixation was superior to the single-segment fixation in the correction of kyphosis.

Comparison of clinical and radiological outcomes of local morselized bone grafts and structural iliac bone grafts in the treatment of lumbar tuberculosis with posterior-only surgery

Background

Many surgeons have reported results similar to those of anterior debridement and bone grafting in treating spinal tuberculosis in the lumbar region using only a posterior approach. However, there is still no consensus regarding bone graft methods. This study aims to compare the clinical and radiological outcomes of morselized versus structural iliac bone grafts in the treatment of lumbar tuberculosis via one-stage posterior surgery.

Methods

A retrospective study was performed with 82 patients with lumbar tuberculosis who had undergone posterior-only debridement, bone grafting, and instrumentation between January 2014 and June 2018. Morselized bone grafts were used in 43 patients, whereas structural iliac bone grafts were used in 39 patients. The clinical data and imaging results of the patients were compared between the two groups to evaluate the clinical effects of the two types of grafts.

Results

The operation time, blood loss and hospital stay values in the morselized bone group were significantly lower than those in the structural iliac bone group (p < 0.05). No significant differences were observed with respect to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle, or improvement of neurological function between the two groups. The VAS pain scores for low back and leg pain decreased significantly after the operation (p < 0.05). However, postoperatively, the VAS score was higher in the structural iliac bone group than in the morselized bone group, and there was no significant difference at the last follow-up between the two groups (p > 0.05). Bone fusion was achieved in 41 patients (95%) in the morselized bone group and 38 patients (97%) in the structural iliac bone group. There was no significant difference between the fusion rates of the two groups (p > 0.05).

Conclusion

The two graft techniques achieved comparable clinical outcomes in lumbar spinal tuberculosis treatment. However, the morselized bone graft was more beneficial in terms of reducing surgical trauma and postoperative complications.

Spinous Process Combined With a Titanium Mesh Cage as a Bone Graft in the Stability Reconstruction of Lumbar or Lumbosacral Spinal Tuberculosis

Background

Autogenous bone grafts, such as iliac bone or rib struts, have been used in the anterior reconstruction of spinal tuberculosis (STB) and have their own benefits and limitations. Here, we introduced a new method, the spinous process (SP), combined with a titanium mesh cage (TMC) as a bone graft in the stability reconstruction of lumbar or lumbosacral STBs. By retrospectively comparing patients who received SP+TMC to traditional TMC bone grafts or allogeneic bone grafts in terms of safety, efficacy and cost-effectiveness, we aimed to evaluate whether SP+TMC could be a possible alternative method.

Methods

From 2010 to 2018, 69 patients who underwent one-stage posterior debridement with grafts and internal fixation within a single lumbar or lumbosacral segment were included in this study. Twelve patients who received SP combined with a TMC (SP+TMC, group A), 30 patients who received a TMC only (group B), and 27 patients who received allografts (group C) were included. Measurements including operative time, blood loss, length of hospital stay, visual analog scale (VAS) score, Oswestry Disability Index (ODI), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), American Spinal Injury Association Impairment (ASIA) grade, final follow-up (FFU) duration and postoperative complications were recorded. Radiological measurements, including the number of segments fixated, the number of pedicle screws used, the Cobb angle, pelvic parameters, and the bony fusion time, were reviewed. All outcomes were analyzed using SPSS 25.

Results

We found that the SP+TMC group had fewer fixation segments, fewer pedicle screws implanted, a shorter operative time, reduced blood loss, and a considerably lower hospital cost than allografts. In addition, the TMC group had a comparable clinical outcome with the TMC group regarding lower economic cost.

Conclusion

Our study demonstrates that compared to a TMC or allograft, the use of SP combined with a TMC as a bone graft is an effective and reliable approach for the surgical management of one-level lumbar or lumbosacral spinal tuberculosis, leading to effective restoration of spinal stability. Furthermore, this approach is a cost-effective structural bone grafting method, especially for patients in developing countries.

Pulmonary embolism following the third thoracic tuberculosis surgery: A case report and literature review

Background

The study aimed to analyze the clinical effects of pulmonary embolism succeeding a third surgery conducted for multiple recurrences in thoracic tuberculosis (TB).

Case report

A 74‐year‐old female patient developed thoracic tuberculosis and was subsequently treated in our hospital in March 2019, October 2020, and February 2021. The third surgical intervention included anterolateral thoracic lesion resection, internal fixation, posterior spinal tuberculous sinus resection, and debridement with suture. The operative time was 172 min resulting in a substantial intraoperative blood loss (2321 ml). Postoperative re‐examination of chest CTPA indicated a strip filling defect and pulmonary embolism in the external branch of the right middle lobe of the lung. After completing the active treatment, the D‐dimer quantification, WBC, CRP, and ESR values were 1261 ng/ml, 7.71 × 10⁹/L, 74.66 mg/L, and 63 mm, respectively. Chest CTPA re‐examination after the treatment showed no signs of pulmonary embolism.

Conclusion

Patients with a long‐term history of multiple operations, high BMI, cerebral infarction, diabetes, and older age group were more likely to develop pulmonary embolism after spinal tuberculosis surgery. Thus, the possibility of postoperative pulmonary embolism should be thoroughly analyzed before any subsequent surgical treatment in patients with recurrent spinal tuberculosis.

Analysis of Clinical Characteristics of 556 Spinal Tuberculosis Patients in Two Tertiary Teaching Hospitals in Guangxi Province

Spinal tuberculosis (STB), which accounts for half of musculoskeletal tuberculosis, is among the leading causes of extrapulmonary tuberculosis. Guangxi Province, located in southern China, is among the most severely affected provinces in China. In this study, we collected and analyzed data from 2 Class-A tertiary teaching hospitals in Nanning City, Guangxi Province, from 2011 to 2019, with the aim of providing reference points for the prevention, diagnosis, treatment, and prognosis analysis of STB, using the epidemiological characteristics of 556 STB cases. Our results revealed that males had a slightly higher incidence (50.17%) compared to females (49.83%), with 64.93% of cases falling between the ages of 18 and 45 years. Cases from rural communities accounted for 63.49% of the reviewed cases. The average time between onset of symptoms and hospitalization was 18.0 months (range: 1 day-220 months). The most commonly reported symptoms were lower back pain (78.60%), radicular pain (51.98%), and systemic toxemia (43.53%). Additionally, 53.98% of the reviewed cases had varying degrees of neurological impairment. The main pathological lesion locations were the lumbar spine (43.53%) and thoracic spine (32.55%). Among them, 72.66% of cases involved at least 2 vertebral segments, and 62.77% of cases presented with paravertebral abscesses. Among the cases reviewed, 90.65% underwent antituberculosis chemotherapy prior to surgery. Following treatment, the cure rate was 78.41%, while 3.78% of patients had postoperative relapse. There were cases of concomitant illnesses among the cases reviewed, 40.65% of patients also had pulmonary tuberculosis, 15.29% had hepatitis B, 13.30% had diabetes, and 7.91% had hypertension. Our results still demonstrate that spinal tuberculosis remains a serious public health problem in Guangxi Province. Thus, preventive measures should be directed towards rural residents with comorbidities such as the elderly and diabetic.

Medium-Term Follow-Up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

Objective

To evaluate the medium‐term outcomes of one‐stage posterior lumbosacral or lumbopelvic fixation treatment of lumbosacral junction tuberculosis in adults.

Methods

This retrospective study enrolled a total of 38 adult patients (24 males and 14 females) with an average age of 48.0 ± 13.0 years (range, 25–75 years) during the period from February 2008 to July 2015. All patients were treated by one‐stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. After pedicle screw or iliac screw fixation, a hemi‐laminectomy or laminectomy was performed on the severely damaged side of the lesion segment. Intervertebral bone grafting and intertransverse bone grafting were performed after clearing the focus of tuberculosis. All cases were followed up for at least 5 years. Intraoperative blood loss, operative time, erythrocyte sedimentation rate (ESR), pain intensity was assessed by visual analog scale (VAS) score; neurological function was assessed by Japanese Orthopaedic Association (JOA) score; quality of life was assessed by Oswestry Disability Index (ODI); functional outcome, lumbosacral angle, and fusion time were gathered and analyzed. All data expressed as mean ± standard deviation.

Results

During the 66.2 ± 4.4 months (range, 60–78 months) follow‐up, all patients achieved clinical cure without severe complications. The intraoperative blood loss was 726.3 ± 151.9 mL (range, 400–1100 mL) and the operative time was 137.6 ± 22.5 min (range, 110–200 min). The ESR decreased to normal levels within (11.8 ± 2.6 mm/h) 3 months postoperatively. The VAS score significantly decreased from 6.8 ± 1.1 preoperatively to 0.8 ± 0.7 at the final follow‐up (P < 0.01). The mean JOA improved from preoperative 18.5 ± 2.9 to 26.9 ± 1.1 at the last visit (P < 0.01). The mean ODI was 44.3 ± 6.7 and significantly decreased to 9.3 ± 1.9 at the final observation (P < 0.01). Patient‐reported outcomes as measured by Kirkaldy‐Willis criteria were excellent in 21 cases, good in 16 cases, and fair in one case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4° (P < 0.01), with an angle loss of 1.2° ± 0.7° at the last follow‐up. Bone fusion occurred on average 12.8 ± 1.9 months (range, 9–15 months) after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow‐up.

Conclusion

One‐stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is an effective and highly safe procedure to treat lumbosacral junction tuberculosis in adults.

Unilateral Limited Laminectomy for Debridement to Treat Localized Short-Segment Lumbosacral Spinal Tuberculosis: A Retrospective Case Series

Objective

This study aimed to investigate the clinical effects of surgically treating lumbosacral tuberculosis with a modified posterior unilateral limited laminectomy method for debridement.

Methods

This retrospective study enrolled a total of 26 patients who were administered in our institution from January 2010 to December 2016, diagnosed with lumbosacral tuberculosis at the L5/S1 level, and underwent one‐stage posterior unilateral limited laminectomy as surgical treatment for debridement, allograft of cortical bone grafting, and fixation. The erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) level, visual analog scale (VAS) score, Oswestry Disability Index (ODI), and lumbosacral angle (LA, Cobb's method) were statistically compared, and the American Spinal Injury Association Impairment (ASIA) Scale was compared between the preoperative and postoperative time points to evaluate the clinical outcomes.

Results

All 26 patients were observed during the follow‐up period, and the mean follow‐up time was 1.3 ± 0.42 years. The mean age was 56 ± 7.4 years old. The average operation time was 118.1 ± 17.5 min, and the mean bleeding volume was 513.0 ± 79.6 mL. There were no intraoperative complications or tuberculous sinus, and two cases experienced hypostatic pneumonia during hospitalization, which resolved with responsive antibiotics and symptomatic supportive treatment. At the final follow‐up, there was no recurrence of tuberculosis, and the ESR (11.8 ± 1.8 mm/h) and CRP (3.0 ± 1.0 mg/L) levels in all patients had returned to normal. The patients with neurologic deficits had improved, and the mean ODI was 79.9 ± 10.6 (87–62) preoperatively and significantly decreased to 20.5 ± 5.7 (11–29) at the final follow‐up (P < 0.01). ASIA scale scores were improved by 1~2 grades at the last follow‐up. The patients' pain levels were significantly alleviated; the mean VAS score declined to 1.2 ± 0.4 (0–2.5) at the final follow‐up compared to 7.5 ± 1.6 (6.5–8.5) preoperatively (P < 0.01). All patients achieved bony graft fusion at an average time of 6.8 ± 1.2 months. Physiological lumbar lordosis was significantly improved, and the mean LA before operation was 17.6° ± 2.1°, which was significantly different from the postoperative LA (29.3° ± 7.4°, P < 0.01) at the final follow up. The LA (27.1° ± 5.5°, P = 0.15) slightly rebounded but without significance compared to the postoperative level.

Conclusion

Only posterior approach by unilateral limited laminectomy for debridement could be served as an effective and safe method to treat short‐segment lumbosacral tuberculosis without extensive anterior sacral and gravitation abscesses.

Early surgical intervention for active thoracic spinal tuberculosis patients with paraparesis and paraplegia

Background

To explore the therapeutic effect of early surgical intervention for active thoracic spinal tuberculosis (TB) patients with paraparesis and paraplegia.

Methods

Data on 118 active thoracic spinal TB patients with paraparesis and paraplegia who had undergone surgery at an early stage (within three weeks of paraparesis and paraplegia) from January 2008 to December 2014 were retrospectively analyzed. The operation duration, blood loss, perioperative complication rate, VAS score, ASIA grade and NASCIS score of neurological status rating, Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle, and duration of bone graft fusion were analyzed to evaluate the therapeutic effects of surgery.

Results

The mean operating time was 194.2 minutes, and the mean blood loss was 871.2 ml. The perioperative complication rate was 5.9 %. The mean preoperative VAS score was 5.3, which significantly decreased to 3.2 after the operation and continued decreasing to 1.1 at follow up (P<0.05). All cases achieved an increase of at least one ASIA grade after operation. The rate of full neurological recovery for paraplegia (ASIA grade A and B) was 18.0 % and was significantly lower than the rate (100 %) for paraparesis (ASIA grade C and D) (P<0.05). On the NASCIS scale, the difference in the neurological improvement rate between paraplegia (22.2 % ± 14.1 % in sensation and 52.2 % ± 25.8 % in movement) and paraparesis (26.7 % ± 7.5 % in sensation and 59.4 % ± 7.3 % in movement) was remarkable (P<0.05). Mean preoperative ESR and CRP were 73.1 mm /h and 82.4 mg/L, respectively, which showed a significant increase after operation (P>0.05), then gradually decreased to 11.5 ± 1.8 mm/h and 2.6 ± 0.82 mg/L, respectively, at final follow up (P<0.05). The mean preoperative kyphotic Cobb’s angle was 21.9º, which significantly decreased to 6.5º after operation (P<0.05) while kyphotic correction was not lost during follow up (P>0.05). The mean duration of bone graft fusion was 8.6 ± 1.3 months.

Conclusions

Early surgical intervention may be beneficial for active thoracic spinal TB patients with paraparesis and paraplegia, with surgical intervention being more beneficial for recovery from paraparesis than paraplegia.

Treatment of Lumbosacral Tuberculosis with Significant Vertebral Body Loss Using Single-Stage Posterior Surgical Management with a Structural Autograft Combined with a Titanium Mesh Cage

OBJECTIVE

Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss.

METHODS

From May 2011 to June 2018, 15 patients with lumbosacral tuberculosis with significant vertebral body loss had undergone single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation. The pre- and postoperative lumbosacral angle, visual analog scale score, erythrocyte sedimentation rate, C-reactive protein, and neurological status were assessed.

RESULTS

Surgery was successful for all patients, and no patient experienced tuberculosis recurrence during an average follow-up period of 27.3 months (range, 12-60 months). After surgery, the erythrocyte sedimentation rate and C-reactive protein for all patients had returned to normal within 3 months. At the final follow-up examination, the neurological status had improved in all patients who had had neurological deficits preoperatively. The mean preoperative lumbosacral angle was 12.6° (range, 6.7°-17.9°), and had increased to 27.7° (range, 24.3°-34.6°) after surgery. The average lumbosacral angle was 26.4° (range, 22.1°-32.3°), with an average loss of 1.4° (range, 0.6°-2.3°) at the final follow-up visit.

CONCLUSIONS

The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.

One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up

Background

To evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion.

Methods

A total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion was performed. Clinical and radiographic outcomes were compared and analyzed.

Results

All patients were followed-up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4° to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found.

Conclusions

One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion represent effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. This approach may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimal invasiveness and rapid postoperative rehabilitation.

The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

Background

The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.

Methods

We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.

Results

All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6 ± 9.3°. The Cobb angle was reduced to 10.6 ± 2.6° postoperatively and was found to be 11.4 ± 3.1° at the final follow-up. The mean angle correction was 23.0 ± 8.9°, and the correction rate was 66.2 ± 12.2%. The mean angle lost was 0.8 ± 0.9°, and the lost rate was 5.8 ± 5.4% at the final follow-up.

Conclusions

Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up

BACKGROUND

There is no comparative study with long-term follow-up between posterior-only and combined posterior-anterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB.

METHODS

Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed.

RESULTS

The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups.

CONCLUSIONS

Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.

One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes

BACKGROUND

To compare the clinical and radiological outcomes between posterior mono-segment and short-segment fixation combined with one-stage posterior debridement and bone grafting fusion in treating single-segment lumbar spinal tuberculosis (LSTB).

METHODS

Sixty-two patients with single-segment LSTB treated by a posterior-only approach were divided into two groups: short-segment fixation (Group A, n = 32) and mono-segment fixation (Group B, n = 30). The clinical and radiographic outcomes were analyzed and compared between the two groups.

RESULTS

The intraoperative bleeding volume, operation time, and hospitalization duration were lower in Group B than in Group A. All patients achieved the bony fusion criteria. The visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were substantially improved 3 months postoperatively and at the last visit in both groups, with no significant difference between the two groups (P > 0.05). Kirkaldy-Willis functional evaluation at the final follow-up demonstrated that all patients in both groups achieved excellent or good results. The difference in the angle correction rate and correction loss between Groups A and B was not significant (P > 0.05).

CONCLUSIONS

One-stage posterior debridement, bone grafting fusion, and mono-segment or short-segment fixation can provide satisfactory clinical and radiological outcomes. Mono-segment fixation is more suitable for the treatment of single-segment LSTB because the lumbar segments with normal motion can be preserved with less trauma, a shorter operation time, shorter hospitalization, and lower costs.

Treatment of Monosegment Spinal Tuberculosis via Posterior Unilateral Vertebral Lamina Fenestration Debridement and Bone Grafting Fusion Combined with Laminar Reconstruction and Internal Fixation: A Retrospective Case-Control Study with a Minimum 5-Year Follow-Up

OBJECTIVE

To investigate the clinical and imaging outcomes of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and instrumentation compared with the traditional posterior-only method for treating monosegment spinal tuberculosis.

METHODS

Fifty-four patients underwent posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation (group A), and 60 patients underwent 1-stage posterior debridement, laminectomy decompression, bone grafting fusion and instrumentation (group B). The clinical and radiographic outcomes of these groups were analyzed and compared.

RESULTS

Group A had less intraoperative blood loss, shorter hospitalization, and a shorter fusion time than did group B (P < 0.05). At 3 months postoperatively, group A had a lower mean Oswestry Disability Index than did group B (P < 0.05). At the final follow-up, group A had a lower mean visual analog scale pain score and a lower mean ODI than did group B (P < 0.05). Group A had a smaller kyphotic angle loss (1.2° ± 0.6°) and loss rate (4.8% ± 2.5%) than did group B (P < 0.05).

CONCLUSIONS

The procedure of posterior unilateral vertebral lamina fenestration debridement and bone grafting fusion combined with laminar reconstruction and internal fixation is safe and effective in treating monosegment spinal tuberculosis. Compared with the conventional posterior-only approach, this method maximizes the retention and reconstruction of the posterior column and is minimally invasive, achieving faster postoperative recovery with fewer complications.

Debridement and Interbody Graft Using Titanium Mesh Cage, Posterior Monosegmental Instrumentation, and Fusion in the Surgical Treatment of Monosegmental Lumbar or Lumbosacral Pyogenic Vertebral Osteomyelitis via a Posterior-Only Approach

OBJECTIVE

The main objective of the present study was to analyze the efficacy and feasibility of surgical management for patients with monosegmental lumbar or lumbosacral pyogenic vertebral osteomyelitis (PVO) by using one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion.

METHODS

From February 2014 to May 2016, 27 patients with lumbar or lumbosacral PVO were treated by posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion. The degree of damage to the patients' vertebral bodies was one third to one half height. There were 16 male and 11 female, with a mean age of 43.5 years (range, 32-56 years) at the time of surgery. The mean follow-up time was 35.7 months (range, 26-53 months). The clinical efficacy was evaluated on average operation time, blood loss, visual analog scale, erythrocyte sedimentation rate, C-reactive protein level, and neurologic function recovery.

RESULTS

PVO was completely cured and the grafted bone was fused in all 27 patients. There was no recurrent vertebral osteomyelitis infection. Erythrocyte sedimentation rate and C-reactive protein level achieved normal limits within 3 months in all patients. The American Spinal Injury Association neurologic classification was improved in all cases. Pain relief was obtained in all patients.

CONCLUSIONS

Our results showed that one stage posterior debridement, interbody graft using titanium mesh cage, posterior monosegmental instrumentation, and fusion was an effective treatment for patients with one third to one half height of vertebral body damaged in monosegmental lumbar or lumbosacral PVO. The surgical method is characterized as minimum surgical trauma, good pain relief, good neurologic recovery, and good reconstruction of spinal stability.

One stage posterior debridement, non-structural bone graft in the surgical treatment of single segment thoracic tuberculosis: A retrospective single-center cohort study

OBJECTIVE

To compare the clinical efficacy of non-structural with structural bone graft in the surgical treatment of single segment thoracic tuberculosis after one stage posterior debridement.

METHODS

61 patients with single segment thoracic tuberculosis treated by one stage posterior debridement, bone graft fusion and internal fixation were retrospectively analyzed. Among them, 35 cases were admitted from 2015 to 2017 in the non-structural bone graft group and 26 cases were admitted from 2011 to 2015 in the structural bone graft group. The visual analogue scale (VAS), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), neurological function, operation time, operative blood loss, hospital stay, correction and loss of Cobb angle, bone graft fusion time and complications were recorded and analyzed.

RESULTS

Compared with structural bone graft group, the operation time of non-structural bone graft group was shorter and the operative blood loss was less, but the hospital stay was longer (P < 0.05). With the follow-up of 14-44 months, the VAS score, ESR, CRP and neurological function in the two groups were both improved (P < 0.05). The correction and loss of Cobb angle in the non-structural bone graft group were both smaller than those in the structural bone graft group (P < 0.05). The bone graft fusion time of the non-structural bone graft group was significantly shorter than the structural bone graft group (P < 0.05). No significant difference was found in the incidence of complications between the two groups (n.s.).

CONCLUSION

Non-structural bone graft has less surgical trauma and shorter bone fusion time compared with structural bone graft in the surgical treatment of single segment thoracic tuberculosis. The two methods may achieve comparable clinical efficacy in alleviating symptoms, correcting kyphosis and improving neurological function for appropriate cases.

Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review

Background

This study was performed to compare different surgical approaches in the treatment of spinal tuberculosis.

Methods

We conducted a literature search to identify and analyze papers published from January 1966 to April 2018 relevant to comparison of the anterior, posterior, and anterior combined with posterior approaches in the treatment of spinal tuberculosis of the thoracic and lumbar regions.

Results

Twenty-five studies involving 2295 patients were identified in this systematic review. The operative time was significantly longer in the anterior combined with posterior approach than in the other two approaches. Blood loss was significantly greater in the anterior combined with posterior approach (1125.0 ± 275.5 mL) than in the posterior approach (710.4 ± 192.4 mL). The difference in correction of the kyphosis angle among the three procedures was not significant. The overall surgical and transthoracic complications were significantly lower in the posterior approach. The clinical outcome of all patients improved, but there was no significant difference among the three procedures.

Conclusions

Blood loss, overall surgical and transthoracic complications, and the operative time are different among the three approaches. Therefore, different factors must be carefully assessed in deciding among the three procedures.

[Application of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis]

Objective

To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis.

Methods

Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion.

Results

The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002).

Conclusion

One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.

Clinical Characteristics of 1378 Inpatients with Spinal Tuberculosis in General Hospitals in South-Central China

In this retrospective study, charts of inpatients with spinal tuberculosis (STB) treated in large-scale general hospitals in Changsha, Hunan, China, between 2007 and 2016 were reviewed to investigate their clinical characteristics. Demographic, epidemiological and clinical features, imaging findings, treatment methods, and prognosis were summarized and analyzed. There were 1378 patients, 805 males and 573 females, with a mean age of 43.7 years. The mean interval between symptom onset and diagnosis was 16.0 months (range 15 days-240 months). The incidence of back pain, radicular pain and symptoms of systemic toxicity was 92.5%, 40.1%, and 32.1%, respectively. The rate of neurological impairment was 49.9 %. STB was present in two or more vertebrae in 91.1% of patients, with two adjacent vertebrae being involved in 67.9% of them. The lumbar segment (38.2%) was the most frequently affected, followed by the thoracic spine (35.7%). The sacrococcygeal area was the least frequently involved (0.8%). Abscesses were detected in 65.5% of patients. One thousand patients (72.6%) were managed with surgery and 378 (27.4%) with anti-TB drugs only. Cure was achieved in 1215 patients (88.2%), whereas 49 (3.5 %) had relapses. Concomitant pulmonary TB (PTB) was diagnosed in 366 patients (26.6%) and 63 (4.6%) had concomitant diabetes. Compared with the previous five years, the number of older patients, urban patients, and medical staff with STB had increased by 6.1%, 5.2%, and 1.3%, respectively in the five years studied. STB remains a severe public health problem that cannot be ignored. Most of the patients ignored early symptoms and therefore received untimely treatment. Thus, surveillance for and treatment of STB in South-central China requires strengthening. In addition to the current China-wide database of patients with PTB, a China-wide database of patients with STB should also be set up.

Does Preserving or Restoring Lumbar Lordosis Have an Impact on Functional Outcomes in Tuberculosis of the Lumbosacral Region?

STUDY DESIGN

Single-center retrospective cohort analysis.

OBJECTIVES

To analyze the impact of loss of global lumbar lordosis (GLL) on functional outcomes in tuberculosis of the lumbar and lumbosacral spine and to define strategies to restore or preserve the physiological lumbar lordosis.

SUMMARY OF BACKGROUND DATA

In tuberculosis of lumbosacral spine, loss of lumbar lordosis (LL) leads to altered lumbosacral biomechanics. All available studies have assessed treatment outcomes with respect to physical well-being, neurologic improvement, bone healing, and changes in radiologic parameters. None have studied the correlation between functional outcomes and LL following treatment. We reviewed 63 patients with tuberculosis of lumbar and lumbosacral spine, with an attempt to analyze the impact of loss of GLL on functional outcomes and have defined strategies to restore the same.

METHODS

We retrospectively reviewed 63 patients with lumbar and lumbosacral tuberculosis, treated conservatively (n = 33) or surgically (n = 30) from March 2007 to July 2013. Average follow-up was 43.1±7.2 months. The correlation between posttreatment GLL and the functional outcome (Oswestry Disability Index), measured at 36 months' follow-up, was analyzed.

RESULTS

All patients showed good bone healing (at 8.4±1.5 months), significant improvement in neurology, VAS scores, ESR and CRP, p<0.001. Mean loss of GLL in the conservatively treated group was 6.4°±5.7°, whereas there was an average gain of 10.9°±9.9° of GLL with surgery. In all patients with minimal disability at the end of treatment, the final GLL was above 40°. In patients with severe disability and in a few with moderate disability, the posttreatment GLL was below 40°. Pearson's test showed a strong negative correlation between final posttreatment GLL and the degree of disability (r = -0.867, p<0.001).

CONCLUSIONS

Early disease with minimal loss of lordosis can be managed conservatively, whereas in advanced disease with gross hypolordosis/kyphosis, posterior stabilization with or without global spinal reconstruction is essential to regain LL. The management of lumbosacral tuberculosis should aim at preserving or restoring the normal LL to achieve good functional outcomes.

LEVEL OF EVIDENCE

Level III.

Posterolateral decompression, bone graft fusion, posterior instrumentation, and local continuous chemotherapy in the surgical treatment of thoracic spinal tuberculosis

To investigate the clinical efficacy of surgical treatment for thoracic spinal tuberculosis with kyphosis deformity via posterolateral debridement, fusion, posterior instrumentation and local continuous chemotherapy. A total of 25 patients with thoracic tuberculosis received surgery by posterolateral decompression, fusion, posterior instrumentation, and postural drainage with local continuous chemotherapy between June 2009 and October 2011. The clinical outcomes was evaluated using statistical analysis about deformity correction, bone fusion, neurologic status, and the visual analog score (VAS) and erythrocyte sedimentation rate (ESR). All of 25 patients were followed up for 39.0 ± 10.7 months (range, 24-60 months) postoperatively. There was no recurrence of tuberculosis, breakage and looseness of internal fixation. Bony fusion was achieved in all cases with 6.7 ± 1.9 months. The values of ESR recovered to normal within 6 months postoperatively. All patients with neurological deficit had significant improvement at the final follow-up. The average preoperative Cobb angles were significantly decreased to 12.2 ± 2.9° (range, 8-17°) postoperatively, and at final follow-up were 12.9 ± 2.7°. Our results showed that single-stage posterolateral debridement fusion, posterior instrumentation and local continuous chemotherapy can be expected to yield satisfactory clinical and radiographic outcomes in patients with thoracic spinal tuberculosis.

Bilateral costotransverse and local continuous chemotherapy approach for debridement, fixation, and fusion of contiguous multisegmental thoracic spinal tuberculosis: A retrospective study

The study aims to evaluate the clinical efficacy of bilateral costotransverse debridement, transpedicular fixation, fusion, and local continuous chemotherapy in 20 patients of contiguous multisegmental thoracic spinal tuberculosis (CMTSTB). We analyzed 20 patients with contiguous thoracic spinal tuberculosis (TB) who underwent surgery via bilateral costotransverse debridement, fusion, posterior instrumentation, and postural drainage with local continuous chemotherapy. The clinical outcomes were evaluated in terms of kyphotic angle, bone fusion, neurologic status, erythrocyte sedimentation rate (ESR), and intraoperative and postoperative complications. All of the patients (8M/12F), averaged 45.8 ± 15.6 years old. The mean duration of postoperative follow-up was 30.7 ± 4.0 months. There was no recurrent TB infection. The values of ESR returned to normal levels at final follow-up. All patients got bony fusion within 8.1 ± 2.3 months after surgery. The average preoperative Cobb angle was 39.9° ± 8.6°, correcting to 9.8° ± 2.3° postoperatively and 10.8° ± 2.3° at the last follow-up. All patients with neurological deficit had dramatic improvement at the final follow-up. Our results showed that bilateral costotransverse surgery and local continuous chemotherapy are feasible and effective procedures in the treatment of CMTSTB. The approach can provide radical debridement, rebuild spinal stability, and cure TB.

The clinical outcomes and surgical strategy for cervical spine tuberculosis: A retrospective study in 78 cases

Literature on the treatment of cervical spinal tuberculosis (CSTB) is uncommon, the surgical approaches to cervical spinal tuberculosis were controversial. The aim of the study was to evaluate the clinical outcomes of 3 surgical techniques in CSTB patients, and to determine the most appropriate approach for CSTB patients. Between April 2006 and June 2012, we performed a retrospective review of clinical and radiographic data that were collected from 850 consecutive spinal tubercular patients, including 87 patients who were diagnosed and treated for CSTB in our hospital. Apart from 9 patients being treated conservatively, the remainder (78 cases) underwent surgery by anterior debridement, interbody fusion and instrumentation (A group), posterior instrumentation and anterior debridement, fusion and instrumentation in a single or two-stage operation (AP group), or posterior debridement, fusion and posterior instrumentation (P group). The patients were evaluated preoperatively and postoperatively on the basis of hematologic, radiographic examinations, and neurologic function. The 78 patients were followed up for a mean duration of 41.2 ± 7.2 months (range, 24-65 months). Postoperatively, the preoperative erythrocyte sedimentation rate (ESR) value returned to normal within 3 to 6 months in all patients, and solid bone fusion was achieved in 3 to 8 months. The patients exhibited significant improvement in deformity and neurological deficit postoperatively, while the visual analog scale for pain showed significant improvement in all patients at the last follow up visit. The follow-up outcomes demonstrated that all 3 surgical methods were viable management options for CSTB. Individualized therapeutic strategies should be selected according to the patient's general condition, focal characteristics, and the surgeon's experience.

Recurrent complex spinal tuberculosis accompanied by sinus tract formation: causes of recurrence and clinical treatments

Recurrent complex spinal tuberculosis accompanied by sinus tract formation is one of the most common and complex types of recurrent tuberculosis. To date, only very few studies have reported the strategies and effectiveness of surgical treatments on postoperative recurrent spinal tuberculosis accompanied by sinus tract formation. In this study, 21 recurrent patients out of 87 patients with complex spinal tuberculosis were reviewed. The data of the patients, including age, gender, existence of drug-resistant mycobacterium tuberculosis, postoperative standard chemotherapy, completeness of lesion debridement, reconstruction of the spinal stability, nutritional status, accompaniment by tuberculosis in other regions, timing of the operations, and areas of the lesions, were collected for single- and multiple-factor analyses. The clinical outcomes were evaluated by long-term follow-ups. The results showed that 7 factors were significantly associated with postoperative recurrence of complex spinal tuberculosis accompanied by sinus tract formation. This suggested that when we treat complex spinal tuberculosis, we should pay more attention to these seven indicators to avoid postoperative recurrence, and our clinical outcomes suggested that it is difficult to treat recurrent complicated spinal tuberculosis combined with sinus tract formation. The key for successful surgical treatment includes effective chemotherapy, radical debridement and proper reconstruction of spinal stability.

A medium-term follow-up of adult lumbar tuberculosis treating with 3 surgical approaches

Surgical intervention is an important option for treating lumbar tuberculosis. Previous studies have reported different surgical intervention procedures. To our knowledge, few studies have compared the clinical results of mid-term follow-up of 3 different surgeries in surgical treatment of spinal tuberculosis. This study's purpose is to evaluate the effectiveness of 3 different surgeries for the treatment of lumbar tuberculosis in adult and analyze the mid-term influence of the surgery on quality of life.Between June 2004 and January 2010, a total of 137 adult patients (54 women and 83 men) with lumbar tuberculosis were recruited for this study. The patients were divided into 3 groups based on administered surgeries: posterior, anterior, and combined posterior-anterior. The trauma index (operation time, blood loss, length of hospital stay, and complications), imaging parameters (segment kyphotic angle, correction rate, loss angle, and bone fusion time), and quality-of-life indicators, including Oswestry Disability Index (ODI), the Frankel grade, visual analog scale (VAS), and Macnab score, were collected.The posterior group experienced the lowest trauma index, whereas the combined group faced the highest trauma index. The anterior group's kyphosis correction rate of (52% ± 5.45%) was significantly inferior to the posterior group (74% ± 5.04%) and the combined group (69% ± 7.95%), whereas the loss of correction in the anterior group (2.5°) was higher than the losses of correction in the posterior group (0.8°) and combined group (1.1°). The mean bone fusion times of the 3 groups were similar. Postsurgery quality of life was markedly improved in all patients. The improvement rates of the ODI, VAS, and the excellent and good rate per the Macnab score were similar among the 3 groups at the final follow-up.Based on a retrospective study, for patients with lumbar tuberculosis, use of the anterior approach should be limited. Although the combined approach produced satisfactory outcomes, it remains more traumatic. Compared with the anterior surgery and the combined surgery, the posterior-only approach is safer and less invasive.

Comparison of Three Surgical Approaches for Thoracic Spinal Tuberculosis in Adult: Minimum 5-Year Follow Up

STUDY DESIGN

Retrospective study.

OBJECTIVE

To assess the minimum 5-year follow up outcomes of the surgical management of adults with thoracic tuberculosis by comparing posterior only (PO), anterior only (AO), and combined posterior and anterior (AP) surgical approaches.

SUMMARY OF BACKGROUND DATA

Surgeons use multiple methods to treat spinal tuberculosis, including an anterior, posterior, and combined anterior and posterior approach. However, there are a few reports comparing the mid- and long-term outcomes of these surgical methods.

METHODS

The medical records for 184 patients treated for thoracic tuberculosis between January 2003 and November 2010 were retrospectively reviewed. Among them, 62 patients were treated with a single-stage posterior debridement and interbody fusion with instrumentation (Group A), 65 patients with posterior instrumentation, anterior debridement, and bone graft in a single or two-stage procedure (Group B), and 57 patients with anterior debridement and strut grafting with instrumentation (Group C). Operative time, blood loss, Visual Analog Scale for pain, complications, recovery of neurological function, Cobb angle, correction rate, and loss angle were compared among all groups.

RESULTS

Groups A, B, and C were followed for 72.7 ± 3.8 months, 74.3 ± 4.2 months, and 73.6 ± 4.5 months, respectively. The operative time, blood loss, and rate of complications for Group A were significantly less than Groups B and C (P < 0.05). The correction rate and loss angle were superior in Groups A and B compared with C, whereas the Visual Analog Scale for pain and fusion time showed no statistically significant difference among the groups (P > 0.05).

CONCLUSION

For patients with thoracic tuberculosis, use of the AO approach should be limited. Although the AP approach produced satisfactory outcomes, it remains more traumatic. Therefore, the PO approach is recommended, not only because it achieves good results, but because it has reduced complications, operative time, and blood loss.

LEVEL OF EVIDENCE

3.

Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis

PURPOSE

Whether radical debridement is necessary for the treatment of thoracic and lumbar tuberculosis is still questionable. The objective of this prospective randomized study was to compare the outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar tuberculosis.

METHODS

Seventy-four thoracic and lumbar tuberculosis patients with a neurological function of grade D and E underwent surgery and received the same chemotherapy regiment from January 2009 to October 2014. All patients were divided into group A and B by taking the drawing of lots. In group A, radical debridement, bone graft, and instrumentation were performed. Isolated posterior instrumentation without debridement were performed in group B. The operative time, blood loss, visual analogue score (VAS), erythrocyte sedimentation rate (ESR), kyphotic angle, Frankel grading, fusion rate, and complications were evaluated.

RESULTS

Group B had a better clinical outcome with regard to the operative time, blood loss, VAS score first week post-operatively, and the ESR value in the third and sixth month post-operatively than group A, and the differences between the two groups about those values all presented a significant difference (P < 0.05). However, no difference was observed between the two groups for the kyphotic angle (P = 0.088) and fusion rate (P = 0.164) at the final follow-up. Neurological function of all cases exhibited normal neurological function in the two groups at the final follow-up. Two cases of pulmonary infection and four cases of wound infection in group A. No serious complications were observed in group B.

CONCLUSIONS

Isolated posterior instrumentation without debridement is a suitable treatment for selected patients because of minor surgical trauma, fewer complications, and spontaneous fusion.