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Zhang W, Liu J, Tai H. Oblique lateral interbody fusion for lumbar tuberculosis. Asian J Surg 2024:S1015-9584(24)00725-5. [PMID: 38677930 DOI: 10.1016/j.asjsur.2024.04.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/12/2024] [Indexed: 04/29/2024] Open
Affiliation(s)
- Wenhui Zhang
- Gansu Provincial Hospital, Lanzhou, Gansu, China
| | - Jie Liu
- Gansu Provincial Hospital, Lanzhou, Gansu, China.
| | - Huiping Tai
- Gansu Provincial Hospital, Lanzhou, Gansu, China.
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2
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Liu Y, Park CW, Sharma S, Kotheeranurak V, Kim JS. Endoscopic anterior to psoas lumbar interbody fusion: indications, techniques, and clinical outcomes. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:2776-2795. [PMID: 37067598 DOI: 10.1007/s00586-023-07700-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The retrospective study aimed to report the surgical technique and clinic-radiological outcomes of endoscopic anterior to psoas interbody lumbar fusion through the retroperitoneal approach with direct and indirect decompression. METHODS We retrospectively analyzed the results of clinical parameters of patients who underwent endoscopic anterior to psoas interbody lumbar fusion between June 2013 and June 2022. Clinical outcomes were evaluated by the visual analog scale (VAS) and Oswestry Disability Index (ODI) scores. The radiological outcomes were measured and statistically compared in disc height index (DHI), whole lumbar lordosis (WLL), pelvic Incidence (PI), pelvic tilt (PT), Segmental lordosis (SL), the sagittal vertical axis (SVA). RESULTS A total of 35 patients were selected for the procedure ranging in age from 51 to 84 years with 17.83 ± 8.85 months follow-up. The mean operation time in lateral position for one level was 162.96 ± 35.76 min (n = 24), and 207.73 ± 66.60 min for two-level fusion. The mean endoscopic time was 32.83 ± 17.71 min per level, with a total estimated blood loss of 230.57 ± 187.22 cc. The mean postoperative VAS back, leg pain score and ODI improved significantly compared to the preoperative values; Radiological data showed significant change in WLL, SL, DHI, PI, PT, and SS; however, there is no significant difference in SVA postoperatively. Subgroup analysis for the radiographic data showed 50 mm length cage has significantly improved for the DHI, SS and SVA compare to 40 mm length cage. The subgroup analysis results showed that hypertensive patients had significantly higher proportion in the incomplete fusion group compare to complete fusion group at one-year follow-up. OUTCOMES The endoscopic anterior to psoas interbody lumbar fusion achieves satisfactory indirect and direct decompression. This convergent technique presents an effective choice for treating lumbar instability associated with disc herniations and foraminal stenosis, thus complementing the indications for oblique lumbar interbody fusion.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Chan Woong Park
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea
| | - Sagar Sharma
- Smt. SCL General Hospital, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, 10330, Thailand
| | - Jin-Sung Kim
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea.
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Mansour M, Tanta N, Ismail G, Alsuliman T, Salman I. A complex surgery of spinal tuberculosis with a psoas abscess accompanied by fibula autografting: an alternative treatment of Pott's disease. J Surg Case Rep 2023; 2023:rjac635. [PMID: 36636651 PMCID: PMC9831644 DOI: 10.1093/jscr/rjac635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
The most common manifestation of skeletal tuberculosis is tuberculosis spondylitis. Symptoms may progress insidiously from back pain to cause many severe complications. Early diagnosis and management of spinal tuberculosis have special importance in prevention. We report a case of a 24-year-old female who was diagnosed with tuberculous spondylitis, complicated with psoas abscess and grade 1/5 of lower limb weakness. The patient was treated with anti-tuberculous drugs and underwent surgical debridement, interbody fusion and internal fixation accompanied by fibular autografting using a posterior-only approach and supplemental posterior spinal stabilisation on an infected background. Within 14 years of follow-up, full bone graft spinal fusion has been achieved with no major complications. According to its clinical efficacy and feasibility, this procedure is suggested to be an alternative treatment for Pott's disease.
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Affiliation(s)
- Marah Mansour
- Correspondence address. Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic. Tel: +963997527302; E-mail:
| | - Nour Tanta
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Ghina Ismail
- Faculty of Medicine, Tartous University, Tartous 0000, Syrian Arab Republic
| | - Tamim Alsuliman
- Hôpital Saint Antoine, Rue de Faubourg Saint Antoine, Paris 75012, France
| | - Issam Salman
- Department of Neurosurgery, AlHikma Hospital, Tartous 0000, Syrian Arab Republic
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Wu H, Cui Y, Gong L, Liu J, Fan Y, Zhou Y, Li W. Comparison between single anterior and single posterior approaches of debridement interbody fusion and fixation for the treatment of mono-segment lumbar spine tuberculosis. Arch Orthop Trauma Surg 2022; 142:3643-3649. [PMID: 34021793 PMCID: PMC9596554 DOI: 10.1007/s00402-021-03955-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 05/07/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. METHODS Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. RESULTS The average period of follow-up was 34.3 ± 9.5 months (24-56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. CONCLUSION Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.
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Affiliation(s)
- Hangli Wu
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
- Department of Plastic and Reconstructive Surgery, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Yaqing Cui
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Liqun Gong
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Jun Liu
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Yayi Fan
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
| | - Weiwei Li
- Department of Orthopedic, Shaanxi Provincial People’s Hospital, Xi’an, 710068 Shaanxi China
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Zhang Y, Zhao CS, Chen JM, Zhang Q. Efficacy of single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis. AIDS Res Ther 2022; 19:53. [PMID: 36419079 PMCID: PMC9682655 DOI: 10.1186/s12981-022-00478-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We aimed to observe the clinical effect of single-stage posterior surgery on HIV-positive patients with thoracolumbar tuberculosis. METHODS From October 2015 to October 2019, 13 HIV-positive patients with thoracolumbar tuberculosis who underwent single-stage posterior surgery were retrospectively analyzed (observation group), and 13 HIV-negative patients with thoracolumbar tuberculosis who were matched with the gender, age, operative site, and surgical approach during the same period were selected as the control group. Postoperative complications, hemoglobin, albumin, CD4+T lymphocyte count, operative site, operative time, and blood loss were recorded between the two groups. The clinical efficacy was evaluated by the visual analog scale (VAS), American Spinal Injury Association (ASIA) scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphotic angle, correction rate of kyphosis, angle loss, and bone graft fusion time. RESULTS In the observation group, 7 patients had postoperative complications, including 1 patient with cerebrospinal fluid leakage, 1 patient with nerve root irritation, 1 patient with an opportunistic infection, and 4 with delayed wound healing. In the control group, 2 patients developed postoperative complications, including 1 with nerve root irritation and 1 with delayed wound healing. There was no statistically significant difference in the incidence of postoperative complications between the two groups (P > 0.05). CD4+T lymphocyte count, hemoglobin, and albumin in HIV-positive patients with postoperative complications were statistically different from those without postoperative complications (P all < 0.05). No tuberculosis recurrence was found at the last follow-up, ESR and CRP returned to normal, and there were no statistically significant differences in bone graft fusion time, VAS score, ASIA scale, correction rate of kyphosis, and angle loss between two groups (P all > 0.05). CONCLUSION Single-stage posterior surgery for HIV-positive patients with thoracolumbar tuberculosis could achieve satisfactory clinical efficacy through comprehensive preoperative evaluation, standardized perioperative antiviral and anti-tuberculosis treatments, and prevention of postoperative complications.
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Affiliation(s)
- Yao Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Chang-song Zhao
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Jia-min Chen
- grid.24696.3f0000 0004 0369 153XDepartment of Pathology, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
| | - Qiang Zhang
- grid.24696.3f0000 0004 0369 153XDepartment of Orthopedics, Beijing Ditan Hospital, Capital Medical University, No. 8, Jingshun East Street, Chaoyang District, Beijing, 100015 China
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Feng J, Xia P, Pu F. Safety and efficacy of topical ropivacaine injection for relieving postoperative pain of spinal tuberculosis: A randomized clinical trial. Asian J Surg 2022; 46:1645-1646. [PMID: 36202705 DOI: 10.1016/j.asjsur.2022.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 11/25/2022] Open
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Dahlan RH, Ompusunggu SE, Gondowardojo YRB, Priambodo R, Anugerah SW. Spinal tuberculosis: A case series and a literature review. Surg Neurol Int 2022; 13:196. [PMID: 35673664 PMCID: PMC9168402 DOI: 10.25259/sni_1201_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Spinal tuberculosis (TB) is a common form of extrapulmonary TB. Although the first line of the treatment is anti-TB medications, patients with severe neurological deficits, spinal instability, and/or kyphotic deformity often warrant surgery. Here, we report five cases of spinal TB requiring operative intervention at Hasan Sadikin General Hospital, Bandung, Indonesia. Case Description: We operated on five patients with spinal TB cases from 2019 to October 2021. In addition to appropriate medical management, all five patients successfully underwent laminectomy with or without posterior stabilization. Conclusion: It is essential to establish the diagnosis and surgically manage patients with spinal TB early in the clinical course to minimize residual post-operative neurological deficits.
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Qiu J, Peng Y, Qiu X, Gao W, Liang T, Zhu Y, Chen T, Hu W, Gao B, Deng Z, Liang A, Huang D. Comparison of anterior or posterior approach in surgical treatment of thoracic and lumbar tuberculosis: a retrospective case-control study. BMC Surg 2022; 22:161. [PMID: 35538532 PMCID: PMC9092713 DOI: 10.1186/s12893-022-01611-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the widespread use of the posterior surgery, more and more surgeons chose posterior surgery to treat thoracic and lumbar tuberculosis. But others still believed that the anterior surgery is more conducive to eradicating the lesions, and easier to place larger bone pieces for bone graft fusion. We compared the clinical and radiological outcomes of anterior and posterior surgical approaches and presented our views. METHODS This study included 52 thoracic and lumbar tuberculosis patients at Sun Yat-sen Memorial Hospital from January 2010 to June 2018. All cases underwent radical debridement, nerve decompression, intervertebral bone graft fusion and internal fixation. Cases were divided into anterior group (24 cases) and posterior group (28 cases). Statistical analysis was used to compare the clinical effectiveness, radiological outcomes, complications and other related information. RESULTS Patients in the anterior group and the posterior group were followed up for an average of 27.4 and 22.3 months, respectively. There were no statistically significant differences between groups in the preoperative, postoperative and last follow-up VAS score, ASIA grade and Cobb angle of local kyphosis. Moreover, there were no statistically significant differences in the improvement of neurological function, loss of kyphotic correction, total incidence of complications, operative time, intraoperative blood loss and hospital stay between the two groups (P > 0.05). But there was greater correction of kyphosis, earlier bone fusion, lower incidence of poor wound healing, less interference with the normal spine and less internal fixation consumables and medical cost in the anterior group (P < 0.05). CONCLUSIONS Both anterior and posterior approaches are feasible for thoracic and lumbar tuberculosis. While for thoracic and lumbar tuberculosis patients with a single lesion limited in the anterior and middle columns of the spine without severe kyphosis, the anterior approach surgery may have greater advantages in kyphosis correction, bone fusion, wound healing, protection of the normal spine, and medical consumables and cost.
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Affiliation(s)
- Jincheng Qiu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Yan Peng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Xianjian Qiu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tongzhou Liang
- Musculoskeletal Research Laboratory, Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuanxin Zhu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Taiqiu Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Bo Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Zhihuai Deng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
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Gao Q, Han C, Romani MD, Guo C, Tang M, Wang Y, Deng A, Liu S, Zhang H. Posterior-only debridement, internal fixation, and interbody fusion using titanium mesh in the surgical treatment of thoracolumbar tuberculosis with spinal epidural abscess: a minimum 5-year follow-up. BMC Musculoskelet Disord 2021; 22:917. [PMID: 34724946 PMCID: PMC8561894 DOI: 10.1186/s12891-021-04797-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/17/2021] [Indexed: 11/11/2022] Open
Abstract
Objective To investigate the clinical efficacy and feasibility of posterior-only debridement, internal fixation, and interbody fusion using titanium mesh in the surgical treatment of thoracolumbar tuberculosis (TB) with spinal epidural abscess. Methods From January 2008 to January 2014, a total of 45 patients (27 male and 18 female) were reviewed. The patients were diagnosed with thoracolumbar TB with spinal epidural abscess. The patients underwent posterior-only debridement, internal fixation, and interbody fusion using titanium mesh. Hence, we assessed the intraoperative and postoperative complications, disease recurrences, kyphosis deformity correction, and neurological improvement following the American Spinal Injury Association (ASIA). We used SPSS 22.0 for the statistical analyses. An independent Student’s t-test was used for the analysis of preoperative and postoperative continuous variables. The value of P (P < 0.05) was considered statistically significant. Results The mean age of patients was 37.76 ± 10.94 years (17–59 years). The mean follow-up time was 82.76 ± 12.56 months (60–128 months). The mean kyphosis Cobb angle preoperative was 29.36 ± 13.29° (5–55°) and postoperative was 3.58 ± 5.44° (− 6–13°), given the value of P (P < 0.001). According to the neurological score by the ASIA scale, there were 3 cases of grade B, 11 cases of grade C, 16 cases of grade D, and 15 cases of grade E preoperatively. The neurological score improved by 1 ~ 2 grades. All patients achieved pain relief and the VAS score significantly reduced at the last follow-up (P<0.05). While 1 patient had cerebrospinal fluid leakage, 1 had a neurological complication, 1 had delayed surgical wound healing, and 1 had a disease recurrence. No pseudoarthrosis or implant failure occurred in our patients. All patients achieved solid bone graft fusion. Conclusion For thoracolumbar TB patients with spinal epidural abscess, posterior-only debridement, internal fixation, and interbody fusion using titanium mesh are safe and effective surgical treatments. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04797-2.
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Affiliation(s)
- Qile Gao
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China.,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Chaofei Han
- Department of Burn and Plastic Surgery, The third Xiangya Hospital, Central South University, Changsha, China
| | - Manini Daudi Romani
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
| | - Chaofeng Guo
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
| | - Mingxing Tang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
| | - Yuxiang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
| | - Ang Deng
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
| | - Shaohua Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Hongqi Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, No. 87, Xiangya Road, Changsha, 410008, People's Republic of China
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Kumar V, Salaria AK, Aggarwal A, Dhatt SS. Surgical Approaches in Management of Spinal Tuberculosis. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2021. [DOI: 10.1055/s-0041-1731596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AbstractAlthough the management of spinal tuberculosis (TB) is mainly medical, there are select surgical interventions for the same, especially in the event of complications. However, with multiple choices with regard to approaches and surgical techniques, one is often left with too many options. We, therefore, performed a literature review on the subject with respect to the surgical approaches to control spinal TB. Our aim is to enable the reader to understand the rationale behind various surgical approaches and techniques involved in managing spinal TB.
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Affiliation(s)
- Vishal Kumar
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Amit Kumar Salaria
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Aditya Aggarwal
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sarvdeep Singh Dhatt
- Department of Orthopaedics, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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Shen J, Zheng Q, Wang Y, Ying X. One-stage combined anterior-posterior surgery for thoracic and lumbar spinal tuberculosis. J Spinal Cord Med 2021; 44:54-61. [PMID: 31050607 PMCID: PMC7919898 DOI: 10.1080/10790268.2019.1607454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Context: Surgical intervention is imperative when spinal tuberculosis (TB) is accompanied by severe spinal damage or kyphotic deformity. As one-stage anterior-only or posterior-only surgery for thoracic and lumbar spinal TB has many disadvantages, combined anterior-posterior surgery was proposed to be a more effective strategy.Objective: To examine the clinical outcomes of one-stage combined anterior-posterior surgery for patients with spinal TB.Design: Retrospective investigation design.Setting: All patients were enrolled at the Hangzhou Red Cross Hospital between August 2002 and October 2014.Participants: Sixty-seven patients with thoracic and lumbar spinal TB were studied.Interventions: All patients were treated with one-stage surgery using a combined anterior-posterior approach.Outcome measures: The patients were evaluated preoperatively and postoperatively by measuring their neurological function using the visual analogue scale (VAS) and the Frankel grades, and spinal deformity using the Cobb angle and radiological examinations. All patients were followed up for at least 11 months and up to 96 months.Results: There was a significant postoperative improvement in neurological outcomes, according to VAS scores and Frankel grades. Kyphotic angles were corrected significantly and were maintained during the final follow-up. Bone fusion was achieved within 4-7 months.Conclusion: One-stage surgical treatment via a combined anterior-posterior approach is an effective and feasible method for treating spinal TB.
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Affiliation(s)
- Jian Shen
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People's Republic of China
| | - Qi Zheng
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People's Republic of China
| | - Yifan Wang
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People's Republic of China
| | - Xiaozhang Ying
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, People's Republic of China
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Liang W, Zhang J, Ren Z, Maimaiti M, Mamati F, Abulizi Y, Xu T, Cao R, Sheng J, Sheng W. Comparison of the Clinical Efficacy of 3 Surgical Methods for Treating Spinal Tuberculosis in Children. Med Sci Monit 2020; 26:e926142. [PMID: 33361735 PMCID: PMC7771200 DOI: 10.12659/msm.926142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background This study aimed to investigate the safety and clinical efficacy of 3 different surgical methods for treating spinal tuberculosis (ST) in children. Material/Methods We reviewed the cases of 62 children with ST who were treated in our hospital from January 2010 to December 2014. In this study, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, Frankel classification of neurological function, pain visual analog scale (VAS) score, and kyphosis Cobb (k-Cobb) angle were dynamically monitored to evaluate the efficacy of different surgical methods. Complications in the patients were evaluated at 3 time points: before surgery (T1), after surgery (T2), and during final follow-up (T3). The average follow-up was 27.4 months. Twenty-two patients underwent simple anterior debridement alone or combined with internal fixation (Method A), 13 patients underwent posterior debridement alone (Method B), and 27 patients received anteroposterior debridement and bone graft fusion together with internal fixation (Method C). Results In all 3 groups after surgery, ESR, CRP levels, VAS scores, and k-Cobb angles significantly decreased. However, compared with patients who received Methods B and C, patients who received Method A had a significant rebound in k-Cobb angle and a higher incidence of complications at the T3 time point. The overall reoperation rate during follow-up was 37.10%. Fourteen patients (22.58%) had kyphosis, 2 patients (3.23%) had tuberculosis recurrence combined with kyphosis, and other complications were reported in 5 patients (8.06%). Conclusions Considering the incidence of complications and level of postoperative biochemical indicators, we concluded that caution should be exercised in using an anterior approach to treat pediatric ST.
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Affiliation(s)
- Weidong Liang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jian Zhang
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Zhouliang Ren
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Maierdan Maimaiti
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Fulati Mamati
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Yakefu Abulizi
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Tao Xu
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Rui Cao
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Jun Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
| | - Weibin Sheng
- Department of Spine Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China (mainland)
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Liu H, Luo J, Wang X, Dong X, Hao D. Efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal tuberculosis. J Int Med Res 2020; 48:300060519896743. [PMID: 31937167 PMCID: PMC7113710 DOI: 10.1177/0300060519896743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective The type of surgical treatment that should be adopted for thoracic tuberculosis (TB) remains controversial. This study was performed to compare the clinical efficacy of surgery via the single anterior and single posterior approaches for treatment of thoracic spinal TB. Methods Seventy-eight patients with thoracic TB undergoing surgical treatment were divided into two groups on the basis of the surgical methods employed: Group A (single anterior debridement + bone graft fusion and internal fixation) and Group B (single posterior debridement + bone graft fusion and internal fixation). Results of clinical and imaging examinations were analysed and compared between the two groups. Results The surgical duration and mean hospital stay were significantly longer and the perioperative bleeding volume was significantly higher in Group A than B. At the last follow-up, changes in the American Spinal Injury Association grade showed no obvious differences between the two groups. Before and after the surgery and at the last follow-up, no significant differences were detected in the Cobb angle change or correction rate between the two groups. Conclusion Surgery via the single anterior and single posterior approaches achieved good clinical efficacy in the treatment of thoracic spinal TB.
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Affiliation(s)
- Haiping Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Jing Luo
- Department of Nursing Administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Xiaodong Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Xiaohua Dong
- Department of Cardiovascular, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China
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Zhong Y, Yang K, Ye Y, Huang W, Liu W, Luo J. Single Posterior Approach versus Combined Anterior and Posterior Approach in the Treatment of Spinal Tuberculosis: A Meta-Analysis. World Neurosurg 2020; 147:115-124. [PMID: 33316480 DOI: 10.1016/j.wneu.2020.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 12/02/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Spinal tuberculosis is the most common form of tuberculosis affecting bone and often needs surgical treatment. Single anterior, single posterior, and combined anterior and posterior approaches are the 3 most commonly used approaches in surgical treatment. Clinically, the choice of optimal surgical approach remains controversial. The purpose of this meta-analysis was to evaluate clinical efficacy of single posterior approach versus combined anterior and posterior approach. METHODS Studies comparing surgical treatment of spinal tuberculosis by single posterior approach versus combined anterior and posterior approach were identified in a literature search conducted from study inception to July 2020. Selection of studies, extraction of data, and evaluation of bias risk of studies were performed independently by 2 authors, and meta-analysis was conducted using RevMan 5.3 software. RESULTS The meta-analysis included 15 studies and 793 spinal tuberculosis cases. Single posterior approach was used in 397 patients, and combined anterior and posterior approach was used in 396 patients. There were no statistical differences in visual analog scale score (P = 0.51), correction of Cobb angle (P = 0.14), neurological improvement (P = 0.71), erythrocyte sedimentation rate (P = 0.32), C-reactive protein after operation (P = 0.81), and loss of correction at final follow-up (P = 0.44) between approaches. Single posterior approach was associated with less intraoperative hemorrhage (P < 0.00001), shorter operative time (P < 0.00001), shorter length of hospital stay (P < 0.00001), and fewer complications (P < 0.00001). Combined anterior and posterior approach was associated with shorter fusion time (P = 0.04). CONCLUSIONS Both approaches can achieve satisfactory clinical outcomes. Posterior-only approach can safely and effectively achieve lesion débridement, decompression, and stability reconstruction and maintenance with advantages of less invasive surgery, less bleeding, shorter surgery time and hospital stay, and fewer complications and seems to be superior to combined posterior-anterior approach.
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Affiliation(s)
- Yanchun Zhong
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Kanghua Yang
- Department of Sports Medicine, Ganzhou People's Hospital, Ganzhou, China
| | - Yongjun Ye
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Weimin Huang
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wuyang Liu
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jiaquan Luo
- Department of Spine Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
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Du X, Ou YS, Zhu Y, Luo W, Jiang GY, Jiang DM. Oblique lateral interbody fusion combined percutaneous pedicle screw fixation in the surgical treatment of single-segment lumbar tuberculosis: A single-center retrospective comparative study. Int J Surg 2020; 83:39-46. [PMID: 32927138 DOI: 10.1016/j.ijsu.2020.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/27/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the clinical efficacy of oblique lateral interbody fusion combined posterior percutaneous pedicle screw fixation in the treatment of single segment lumbar tuberculosis. METHODS Patients who underwent surgical treatment for single segment lumbar tuberculosis from 2015 to 2018 in our department were retrospectively included in this study. The included patients were divided into two groups, namely oblique lateral interbody fusion combined percutaneous pedicle screw fixation (OLIF) group and traditional posterior transforaminal or transpedicular approach debridement and pedicle screws fixation (PTA) group, according to the surgical methods. Outcomes including operative time, operative blood loss, hospital stay, visual analogue scale (VAS) score, Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR), C reactive protein (CRP), Cobb angle correction and loss, bone fusion time, ASIA grade and complications were all recorded and compared. RESULTS A total of 60 patients were included in this study, involving 23 patients in the OLIF group and 37 patients in the PTA group. The OLIF group had less operative time, blood loss and shorter hospital stay compared with the PTA group (P < 0.05). Both the two groups achieved significant improvements in ESR, CRP and ASIA grade at the last follow-up (P < 0.05), but no significant differences were found between them (P>0.05). There were no significant differences in Cobb angle correction and loss between the two groups (P > 0.05), but the bone graft fusion time of the OLIF group was significantly shorter than the PTA group (P < 0.05). The two groups achieved similar improvement in VAS score and ODI at 12 months postoperative and the last follow-up, however, OLIF group had a lower VAS score and ODI at 1 month, 3 months and 6 months postoperative (P < 0.05). No significant difference was found in complications between the two groups (P > 0.05) and all patients were cured after active treatment. CONCLUSIONS Both OLIF and PTA can achieve satisfactory clinical efficacy in the surgical treatment of single segment lumbar TB, but OLIF has the advantages of less surgical trauma, faster postoperative recovery and shorter bone fusion time.
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Affiliation(s)
- Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Yun-Sheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Yong Zhu
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Guan-Yin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
| | - Dian-Ming Jiang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, 400016, Chongqing, China.
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Zhao C, Luo L, Liu L, Li P, Liang L, Gao Y, Luo F, Xu J, Zhou Q. Surgical management of consecutive multisegment thoracic and lumbar tuberculosis: anterior-only approach vs. posterior-only approach. J Orthop Surg Res 2020; 15:343. [PMID: 32819392 PMCID: PMC7441607 DOI: 10.1186/s13018-020-01876-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 11/20/2022] Open
Abstract
Purpose To compare the efficacy, safety, and technical characteristics of anterior-only and posterior-only approach surgeries for the treatment of consecutive multisegment thoracic and lumbar tuberculosis. Methods Thirty-five patients who developed consecutive multisegment thoracic and lumbar tuberculosis from September 2012 to May 2016 were retrospectively analyzed. Group A was the posterior-only surgery group, and group B was the anterior-only surgery group. The data on the surgery, deformity correction, functional scores, and complications were compared between the two groups. Results There was no significant difference in the operation time or blood loss between groups A and B (P > 0.05). The preoperative average Cobb angle of kyphosis in groups A and B were 36.2 ± 15.2° and 27.9 ± 7.7°, respectively, which significantly decreased to 4.9 ± 11.8° and 10.4 ± 5.6° after the operation, respectively (P < 0.05). At the final follow-up, the angles were 7.1 ± 10.5° and 14.6 ± 8.0°. The correction angle and correction rate in group A (31.3 ± 16.6°, 88.6 ± 43.6%) were greater than those in group B (17.5 ± 4.4°, 64.9 ± 14.0%) (P < 0.05). There was no significant difference in the loss angle between groups A and B (P > 0.05), but the loss rate in group B (24.0 ± 27.8%) was higher than that in group A (9.6 ± 10.2%) (P < 0.05). There was no significant difference in the incidence of complications between the two groups (P > 0.05). Conclusion The posterior-only and anterior-only approaches can lead to satisfactory clinical results in the treatment of patients with consecutive multisegment thoracic and lumbar tuberculosis. With posterior-only surgery, kyphosis can be better corrected, and the correction can be better maintained than with anterior-only surgery.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Luo
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liehua Liu
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Pei Li
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lichuan Liang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yongjian Gao
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Qiang Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Wang B, Ke W, Hua W, Lu S, Zeng X, Yang C. Biomechanical evaluation of anterior and posterior lumbar surgical approaches on the adjacent segment: a finite element analysis. Comput Methods Biomech Biomed Engin 2020; 23:1109-1116. [PMID: 32633569 DOI: 10.1080/10255842.2020.1789605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to use models of spine to compare range of motion and intradiscal pressure of adjacent segments performing anterior and/or posterior lumbar surgical approaches and predict potential risk of adjacent segment degeneration. A previously validated finite element model of the intact L1-S1 segments was used. Three different anterior and one posterior surgical fixation approaches for tuberculosis were performed in L3-L5. Three different anterior surgical models were constructed according to the anterior approaches involving debridement, bone graft with or without titanium mesh, and internal fixation with different number of screws and rods. The posterior surgical approach involved transforaminal lumbar interbody debridement, bone graft, and internal fixation. Range of motion and intradiscal pressure of segments adjacent to the fusion were assessed, and biomechanical influences were compared. Intradiscal pressure and range of motion of the adjacent L2/3 and L5/S1 increased during different physiological movements after anterior and/or posterior surgical approaches as compared to baseline values. Comparison between the biomechanical values assessed after different anterior surgical approaches yielded no significant difference. After anterior and posterior surgical approaches were performed on the same model, there were no significant differences in intradiscal pressure and range of motion of the adjacent L2/3 and L5/S1. Anterior and/or posterior lumbar surgical approaches increased range of motion and intradiscal pressure in L2/3 and L5/S1, suggesting each lumbar surgical approach assessed has the potential risk of adjacent segment degeneration. However, there were no significant differences between the biomechanical measurements across the different surgical approaches evaluated.
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Affiliation(s)
- Bingjin Wang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wencan Ke
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenbin Hua
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Saideng Lu
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xianlin Zeng
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cao Yang
- Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Luo W, Ou YS, Du X, Wang B. Anterior oblique retroperitoneal approach vs posterior transpedicular approach for the treatment of one- or two-level lumbar vertebral osteomyelitis: a retrospective cohort study. INTERNATIONAL ORTHOPAEDICS 2020; 44:2349-2356. [PMID: 32500308 DOI: 10.1007/s00264-020-04650-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To evaluate the outcomes of debridement fusion surgery between two surgical approaches for one- or two-level lumbar vertebral osteomyelitis (LVO): oblique retroperitoneal approach (ORA) and posterior transpedicular approach (PTA). METHODS We performed a retrospective study for adult patients with one- or two-level lumbar vertebral pyogenic spondylitis. The primary clinical outcomes included the following: surgery-related information (intra-operative blood loss, operation time, and hospital length of stay), infection control (primary failure and recurrence), and bony fusion. The secondary objective was to determine the differences between groups in mean reduction of pain characters and physical functioning. RESULTS The data of 80 patients were collected retrospectively. The duration of follow-up was 27.8 ± 4.7 months (range, 24-42). Intra-operative blood loss, operation time, and hospital length of stay in ORA debridement were significantly lower. Primary failure (2.3% vs 2.7%) was similar between the groups, but recurrence (13.9% vs 5.4%) had difference. Bony fusion (94.6.3% vs 86.1.%) in ORA debridement was higher than those in PTA debridement at the final follow-up. Fusion occurred at six to 14 months (mean 9.8 months). Patients in ORA group had better results in functional and pain scores in the first three months, with similar results at the final follow-up. CONCLUSION In summary, ORA debridement provides a quicker recovery compared with PTA debridement for one- or two-level LVO. As for the infection control and fusion rate, both debridement approaches had similar results.
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Affiliation(s)
- Wei Luo
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
| | - Yun-Sheng Ou
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China.
| | - Xing Du
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
| | - Ben Wang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, No. 1 YouYi Road, Yuan Jia Gang, Yu Zhong District, Chongqing, 400016, People's Republic of China
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Zhao C, Luo L, Pu X, Liu L, Li P, Liang L, Luo F, Hou T, Dai F, Xu J, Zhou Q. Transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis: Minimum 5-year follow-up. Medicine (Baltimore) 2020; 99:e20359. [PMID: 32481417 DOI: 10.1097/md.0000000000020359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the clinical and imaging results of transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis (TB) with a minimum 5-year follow-up.Sixty-five patients who presented with active thoracic and lumbar TB between October 2006 and August 2013 were retrospectively analyzed: 20 were thoracic TB (group A), 17 were thoracolumbar TB (group B), and 28 were lumbar TB (group C). The patient data, operating time, blood loss, Visual Analog Scale score, Oswestry Disability Index score, correction of kyphosis, recovery of neurological function, and complications were recorded and analyzed.The patients were followed for 68.7 ± 17.8 months. The preoperative average Cobb angles of kyphosis in patients in groups A, B, and C significantly decreased from 28.2 ± 11.9°, 30.5 ± 16.9°, and 10.9 ± 8.8° before surgery to 8.0 ± 5.4°, 5.0 ± 4.1°, and -4.4 ± 1.6° (- indicates lordosis) after surgery, respectively. At the final follow-up time, the Cobb angles were 9.2 ± 6.1°, 6.8 ± 10.0°, and -3.7 ± 2.0°, respectively. The postoperative Cobb angles of kyphosis were significantly improved in all groups (P < .05). The correction loss angles were larger in groups A and B than in group C (P > .05). The operating time, blood loss, and complications were not significantly different between the groups (P > .05). Three (4.6%) patients developed unhealed TB during postoperative anti-TB treatment, and 6 patients (9.2%) with TB relapsed after healing from surgery.The posterior-only approach for the surgical treatment of thoracic and lumbar TB achieved satisfactory outcomes over long-term follow-up. The implantation of pedicle screws in diseased vertebrae reduced the range of fixation, but patients with thoracic and thoracolumbar TB should undergo fixation to at least 1 adjacent normal segment. There were some cases of recurrence after TB healed, and long-term follow-up is therefore necessary.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Lei Luo
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Xiaobing Pu
- Department of Orthopedic Surgery, No. 4 West China Teaching Hospital, Sichuan University, Chengdu, Sichuan
| | - Liehua Liu
- Graduate School, Ningxia Medical University, Yinchuan, Ningxia
| | - Pei Li
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Lichuan Liang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Qiang Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
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Multi-drug resistant spinal tuberculosis-epidemiological characteristics of in-patients: a multicentre retrospective study. Epidemiol Infect 2020; 148:e11. [PMID: 31983359 PMCID: PMC7019620 DOI: 10.1017/s0950268820000011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Tuberculosis (TB) is the leading cause of death among infectious diseases. China has a high burden of TB and accounted for almost 13% of the world's cases of multi-drug resistant (MDR) TB. Spinal TB is one reason for the resurgence of TB in China. Few large case studies of MDR spinal TB in China have been conducted. The aim of this research was to observe the epidemiological characteristics of inpatients with MDR spinal TB in six provinces and cities of China from 1999–2015. This is a multicentre retrospective observational study. Patients' information was collected from the control disease centre and infectious disease database of hospitals in six provinces and cities in China. A total of 3137 patients with spinal TB and 272 patients with MDR spinal TB were analysed. The result showed that MDR spinal TB remains a public health concern and commonly affects patients 15–30 years of age (34.19%). The most common lesions involved the thoracolumbar spine (35.66%). Local pain was the most common symptom (98.53%). Logistic analysis showed that for spinal TB patients, reside in rural district (OR 1.79), advanced in years (OR 1.92) and high education degree (OR 2.22) were independent risk factors for the development of MDR spinal TB. Women were associated with a lower risk of MDR spinal TB (OR 0.48). The most common first-line and second-line resistant drug was isoniazid (68.75%) and levofloxacin (29.04%), respectively. The use of molecular diagnosis resulted in noteworthy clinical advances, including earlier initiation of MDR spinal TB treatment, improved infection control and better clinical outcome. Chemotherapy and surgery can yield satisfactory outcomes with timely diagnosis and long-term treatment. These results enable a better understanding of the MDR spinal TB in China among the general public.
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A meta-analysis of the safety and effectiveness of titanium mesh versus bone graft alone for the treatment of thoracolumbar tuberculosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1505-1517. [PMID: 31872301 DOI: 10.1007/s00586-019-06260-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The aim of this study is to investigate, using a meta-analysis, differences in safety and effectiveness between a titanium mesh bone graft and bone graft alone for the treatment of thoracolumbar spinal tuberculosis. METHODS PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang (Chinese) and other databases were searched up to April 2019 using predetermined terms. Published studies investigating the safety and effectiveness of a titanium mesh bone graft versus a bone graft alone for the treatment of thoracolumbar spinal tuberculosis were included. Two authors independently extracted the data and evaluated the quality of the included articles. A meta-analysis of relevant outcome indicators was performed using Stata 14 and RevMan 5.3 software. RESULTS We retrieved 8 retrospective studies that met the inclusion criteria and enrolled a total of 401 patients, including 203 patients in the titanium mesh group and 198 in the bone graft only group. Each study was rated as high quality. The meta-analysis results showed no statistically significant differences between the 2 bone graft methods in terms of surgery-related indicators, clinical effectiveness, imaging and complications. CONCLUSIONS Both titanium mesh and bone grafts alone are effective for the treatment of thoracolumbar spinal tuberculosis based on safety. However, the results of this study do not support the superiority of titanium mesh bone grafts reported in previous studies. Because of the high risk of bias of the conclusions of a meta-analysis of non-randomized studies and the small sample sizes for some of the most important outcomes, randomized controlled trials are expected to further examine the reliability of the present findings.
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Wang K, Wang N, Wang Y, Xia Y, Song F, Liu J. Anterior versus posterior instrumentation for treatment of thoracolumbar tuberculosis : A meta-analysis. DER ORTHOPADE 2019; 48:207-212. [PMID: 30523353 DOI: 10.1007/s00132-018-03662-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND To compare clinical and functional outcomes of anterior versus posterior debridement and spinal fixation for surgical treatment of thoracolumbar tuberculosis. METHODS A computer-based online search of the Cochrane Library, PubMed, EMBase, Wanfang, VIP, and the CNKI database was performed. The methodological quality of included studies was evaluated, and data analyses were performed using RevMan 5.0 software (The Nordic Cochrane Centre, The Cochrane Collaboration Copenhagen, Denmark). RESULTS Eleven trials were studied, with eight performed in China, two in Egypt, and one in India. The results showed significant differences between the two operative approaches in terms of correction of kyphotic angle and intraoperative blood loss, but not in terms of operation time, hospital stay, fusion time, and loss of correction at the final follow-up. CONCLUSION The anterior and posterior approaches are equally good methods for treatment of thoracolumbar tuberculosis. The anterior approach results in less blood loss, whereas posterior instrumentation is better suited for correction of kyphotic angle.
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Affiliation(s)
- Kai Wang
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Na Wang
- Department of Oncology, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Yuliang Wang
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Yayi Xia
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Feixue Song
- Department of Oncology, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China
| | - Jingsheng Liu
- Department of Orthopedics, Second Hospital of Lanzhou University, 730000, Lanzhou, Gansu Province, China.
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Shi J, He J, Niu N, Yang Z, Yuan H, Ding H. [Application of small incision approach in anterior surgery of thoracic and lumbar spinal tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:698-706. [PMID: 31197996 DOI: 10.7507/1002-1892.201812097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis. Methods A clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups ( P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard. Results The length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B ( P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference ( χ 2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up ( P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups ( Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation ( P<0.05); the VAS score in group A was significantly lower than that in group B ( t=-2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups ( t=-0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle ( P<0.05); but there was no significant difference between 1 day after operation and last follow-up ( P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation ( P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up ( P>0.05). At last follow-up, all patients cured, and no recurrence occurred. Conclusion In the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.
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Affiliation(s)
- Jiandang Shi
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004,
| | | | - Ningkui Niu
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P.R.China
| | - Zongqiang Yang
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P.R.China
| | - Haifeng Yuan
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P.R.China
| | - Huiqiang Ding
- Department of Spinal Orthopedics, General Hospital of Ningxia Medical University, Yinchuan Ningxia, 750004, P.R.China
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Zhao C, Pu X, Zhou Q, Huang X, Zhang C, Luo L, Zhang Z, Hou T, Luo F, Dai F, Xu J. Can a posterior approach effectively heal thoracic and lumbar tuberculosis? Microbiology outcomes of the operative area. J Orthop Surg Res 2019; 14:24. [PMID: 30670055 PMCID: PMC6341735 DOI: 10.1186/s13018-019-1063-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/15/2022] Open
Abstract
Background There was a controversy about surgery approach of thoracic and lumbar tuberculosis (TB) treatment. The aim of this study was to compare the microbiology outcomes of the drainage liquid and the clinical outcomes of a posterior and anterior approach in the treatment of thoracic and lumbar TB. Materials and methods A total of 105 patients were enrolled in this prospective study from February 2011 to September 2015. Patients were divided into two groups: group A (51 patients, posterior approach surgery) and group B (54 patients, anterior approach surgery). Intraoperative TB samples were sent for Mycobacterium tuberculosis culture (MTBC). Drainage fluid was postoperatively collected for polymerase chain reaction (PCR), acid-fast strains (AFS), MTBC, and DNA molecular detection (DNAMD) analyses. Compare the drainage liquid positive rate of the two groups and estimate relationship between the positive results of drainage fluid and the lesion region. In addition, the clinical outcomes including the bony fusion, relapse rate, complications, and neurological status were collected. Results There was no significant difference in the positive rate of AFS, PCR, DNAMD, MTBC, or any positive rate (APR) of drainage liquid between the two groups (P > 0.05). In both groups, the MTBC-positive rate of postoperative drainage fluid was significantly lower than that of the intraoperative sample (P < 0.01). There was no significant relationship between APR and the lesion region (P > 0.05). All the patients had at least 2 years of follow-up, with an average of 34.4 ± 15.8 months. There were four patients in group A and two patients in group B who had recurrent spine TB, and the rest of the patients had fusion in the surgical area. There was no significant difference in the incidence of TB recurrence or other complications between the two groups (P > 0.05). All the patients with neurological dysfunction had improved after surgery. Conclusion Compared with anterior approach surgery, posterior approach surgery had equal effectiveness of debridement. The two kinds of surgery can effectively clear the lesions surrounding the spine and heal thoracic and lumbar TB.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Xiaobing Pu
- Department of Orthopedic Surgery, No.4 West China Teaching Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
| | - Qiang Zhou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China.
| | - Xingzhou Huang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Chengmin Zhang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Lei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Zehua Zhang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
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Yin H, Wang K, Gao Y, Zhang Y, Liu W, Song Y, Li S, Yang S, Shao Z, Yang C. Surgical approach and management outcomes for junction tuberculous spondylitis: a retrospective study of 77 patients. J Orthop Surg Res 2018; 13:312. [PMID: 30522509 PMCID: PMC6282286 DOI: 10.1186/s13018-018-1021-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/26/2018] [Indexed: 12/03/2022] Open
Abstract
Background Junction tuberculous spondylitis involves the stress transition zone of the spine and has a high risk of progression to kyphosis or paraplegia. Problems still exist with treatment for spinal junction tuberculosis. This study investigated the surgical approach and clinical outcomes of junction spinal tuberculosis. Methods From June 1998 to July 2014, 77 patients with tuberculous spondylitis were enrolled. All patients received 2–3 weeks of anti-tuberculous treatment preoperatively; treatment was prolonged for 2–3 months when active pulmonary tuberculosis was present. The patients underwent anterior debridement and were followed up for an average of 29.4 months clinically and radiologically. Results The cervicothoracic junction spine (C7-T3) was involved in 15 patients. The thoracolumbar junction spine (T11-L2) was involved in 39 patients. The lumbosacral junction spine (L4-S1) was involved in 23 patients. Two patients with recurrence underwent reoperation; the drugs were adjusted, and all patients achieved bone fusion. The preoperative cervicothoracic and thoracolumbar kyphosis angle and lumbosacral angle were 31.4 ± 10.9°, 32.9 ± 9.2°, and 19.3 ± 3.7°, respectively, and the corresponding postoperative angles were ameliorated significantly to 9.1 ± 3.2°, 8.5 ± 2.9°, and 30.3 ± 2.8°. The preoperative ESR and C-reactive protein level of all patients were 48.1 ± 11.3 mm/h and 65.5 ± 16.2 mg/L which decreased to 12.3 ± 4.3 mm/h and 8.6 ± 3.7 mg/L at the final follow-up, respectively. All patients that had neurological symptoms achieved function status improvement at different degrees. Conclusion For spinal tuberculosis of spinal junctions, anterior debridement, internal fixation, and fusion can be preferred and achieved. If multiple segment lesions are too long or difficult for operation of anterior internal fixation, combining posterior pedicle screw fixation is appropriate.
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Affiliation(s)
- Huipeng Yin
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kun Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yong Gao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yukun Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wei Liu
- Department of Orthopedics, First Hospital of Wuhan, Zhongshan Road, No.215, Wuhan, 430022, China
| | - Yu Song
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Li
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuhua Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cao Yang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Abstract
Aims The surgical treatment of tuberculosis (TB) of the spine consists of debridement and reconstruction of the anterior column. Loss of correction is the most significant challenge. Our aim was to report the outcome of single-stage posterior surgery using bone allografts in the management of this condition. Patients and Methods The study involved 24 patients with thoracolumbar TB who underwent single-stage posterior spinal surgery with a cortical bone allograft for anterior column reconstruction and posterior instrumentation between 2008 and 2015. A unilateral approach was used for 21 patients with active TB, and a bilateral approach with decompression and closing-opening wedge osteotomy was used for three patients with healed TB. Results A median of 1.25 vertebrae were removed (interquartile range (IQR) 1 to 1.75) and the median number of levels that were instrumented was five (IQR 3 to 6). The median operating time was 280 minutes (IQR 230 to 315) and the median blood loss was 700 ml (IQR 350 to 900). The median postoperative kyphosis was 8.5° (IQR 0° to 15°) with a mean correction of the kyphosis of 71.6%. Good neurological recovery occurred, with only two patients (8%) requiring assistance to walk at a mean follow-up of 24 months (9 to 50), at which time there was a mean improvement in disability, as assessed by the Oswestry Disability Index, of 83% (90% to 72%). Conclusion The posterior-only approach using cortical allografts for anterior column reconstruction achieved good clinical and radiological outcomes. Differentiation should be made between flexible (active) and rigid (healed) TB spine. Cite this article: Bone Joint J 2018;100-B:1208–13.
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Affiliation(s)
- U. N. F. Ukunda
- Department of Orthopaedics, Chris Hani
Baragwanath Academic Hospital, Bertsham, South
Africa
| | - M. M. Lukhele
- Department of Orthopaedic Surgery, Charlotte
Maxeke Johannesburg Academic Hospital, Johannesburg,
South Africa
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Gao Y, Ou Y, Quan Z, Jiang D. [Research progress of surgical treatment of thoracolumbar spinal tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:112-117. [PMID: 29806375 PMCID: PMC8414199 DOI: 10.7507/1002-1892.201705124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 12/17/2017] [Indexed: 11/03/2022]
Abstract
Objective To review the progress of surgical treatment for the thoracolumbar spinal tuberculosis. Methods The related literature of surgical treatment for the thoracolumbar spinal tuberculosis was reviewed and analyzed from the aspects such as surgical approach, fixed segments, fusion ranges, bone graft, and bone graft material research progress. Results Most scholars prefer anterior or combined posterior approach for surgical treatment of thoracic and lumbar tuberculosis because it possessed advantage of precise effectiveness. In recent years, a simple posterior surgery achieved satisfactory effectiveness. The fixation segments are mainly composed of short segments or intervertebral fixation. The interbody fusion is better for the bone graft fusion range and manner, and the bone graft materials is most satisfied with autologous iliac Cage or titanium Cage filled with autologous cancellous bone. Conclusion The perfect strategy for treating the thoracolumbar spinal tuberculosis has not yet been developed, and the personalized therapy for different patients warrants further study.
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Affiliation(s)
- Yongjian Gao
- Department of Orthopedics, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, P.R.China
| | - Yunsheng Ou
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010,
| | - Zhengxue Quan
- Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China
| | - Dianming Jiang
- Department of Orthopedics, the Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, P.R.China
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Fisahn C, Alonso F, Hasan GA, Tubbs RS, Dettori JR, Schildhauer TA, Rustagi T. Trends in Spinal Surgery for Pott's Disease (2000-2016): An Overview and Bibliometric Study. Global Spine J 2017; 7:821-828. [PMID: 29238648 PMCID: PMC5722002 DOI: 10.1177/2192568217735827] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES (1) What are the surgical indications? Have they changed over time since the year 2000? (2) What is the current surgical approaches of choice? Have they changed over time since the year 2000? Do they vary by geographical region? (3) What are the most common outcome measures following surgery? METHODS Electronic databases and reference lists of key articles were searched from database inception from January 1, 2000 to December 31, 2016 to identify studies specifically evaluating surgical indications, current surgical approaches, and outcome measures for spinal tuberculosis. RESULTS Six randomized controlled trials were identified from our search (1 excluded: no surgical arm identified after review) Neurological deficit, instability and deformity were common indications identified. Surgical approach included predominantly anterior for cervical spine and posterior for thoracic and lumbar spine. Combined approach was preferred in pediatric cases. Degree of deformity correction, neurological outcomes, and fusion formed the main bases of assessing surgical outcomes. CONCLUSIONS Majority of the current literature is from South Asia. The presence of neurological compromise, deformity, and instability were the primary criteria for surgical intervention. The preferred approach varied with the anatomical region of the spine in adults. Outcome measures predominantly involved deformity correction, neurological deficit, and fusion.
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Affiliation(s)
- Christian Fisahn
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA,BG University Hospital Bergmannsheil, Ruhr University Bochum, Bochum, Germany,Christian Fisahn, Swedish Neuroscience Institute, Swedish Medical Center, 550 17th Avenue, Seattle, WA 98122, USA.
| | - Fernando Alonso
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA
| | - Ghazwan A. Hasan
- Shaheed Ghazi Al-Hariri Specialized Surgical Hospital, Baghdad, Iraq
| | | | | | | | - Tarush Rustagi
- Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, USA,Indian Spinal Injuries Centre, New Delhi, India
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Zhang QH, Guo Q, Guo C, Wu J, Liu J, Gao Q, Wang Y. A medium-term follow-up of adult lumbar tuberculosis treating with 3 surgical approaches. Medicine (Baltimore) 2017; 96:e8574. [PMID: 29137080 PMCID: PMC5690773 DOI: 10.1097/md.0000000000008574] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2016. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:11-19. [PMID: 28062915 DOI: 10.1007/s00586-016-4942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
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