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Feng X, Jia X, Lan Y. Analysis of the clinical effect of posterior focus debridement and interbody bone grafting in the treatment of spinal tuberculosis. Panminerva Med 2023; 65:543-545. [PMID: 34933519 DOI: 10.23736/s0031-0808.21.04461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Xinjian Feng
- Department of Orthopedic, Luzhou People's Hospital, Luzhou, China
| | - Xufeng Jia
- Department of Orthopedic, Jianyang People's Hospital, Jianyang, China
| | - Yunzhu Lan
- Reproductive Center, The Affiliated Hospital of Southwest Medical University, Luzhou, China -
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Maki Y, Takayama M, Go K. Bilateral Percutaneous Transpedicular Drainage under Local Anesthesia for Thoracic Tuberculous Spondylitis. Asian J Neurosurg 2023; 18:327-332. [PMID: 37397050 PMCID: PMC10310438 DOI: 10.1055/s-0042-1748788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023] Open
Abstract
Tuberculous spondylitis is a common spinal infection. If surgical intervention is necessary, anterior debridement and anterior fixation are typically performed. However, a minimally invasive surgical strategy under local anesthesia seems rarely implemented. A 68-year-old man presented with severe pain in the left flank. Whole spinal magnetic resonance imaging revealed abnormal intensity of vertebral bodies from T6-9. A bilateral paravertebral abscess extending from T4-10 was suspected. The T7/T8 intervertebral disc was destroyed, but severe vertebral deformity or spinal cord compression was not observed. Bilateral percutaneous transpedicular drainage under local anesthesia was planned. The patient was set in the prone position. Under the guide of a biplanar angiographic system, the bilateral drainage tubes were placed paravertebrally in the abscess cavity. The left flank pain improved after the procedure. Laboratory culture of the pus specimen confirmed a diagnosis of tuberculosis. A chemotherapy regimen for tuberculosis was soon initiated. The patient was discharged during postoperative week 2, with continuation of chemotherapy for tuberculosis. Percutaneous transpedicular drainage under local anesthesia can be effective in the management of thoracic tuberculous spondylitis without severe vertebral deformity or compression of the spinal cord by an abscess.
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Affiliation(s)
- Yoshinori Maki
- Department of Neurosurgery, Hikone Chuo Hospital, Shiga, Japan
- Department of Rehabilitation, Hikari Hospital, Shiga, Japan
| | | | - Kohichi Go
- Department of Neurosurgery, Otsu City Hospital, Shiga, Japan
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Zhang X, Wang K, Xia Y, Gao X, Du Y, Chen L. Treatment of lavage drainage under spinal endoscopy on lumbar spinal tuberculosis with vertebral lesions. EUR J INFLAMM 2020. [DOI: 10.1177/2058739220961192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
To investigate the efficacy and safety of the treatment of percutaneous endoscopic debridement (PED) and continuous lavage drainage (CLD) on lumbar tuberculosis. Total 31 patients diagnosed with lumbar tuberculosis, who underwent the PED and CLD from January 2012 to January 2018 in our hospital were included. The operation time, intraoperative blood loss, complications were analyzed. The recovery of local tuberculosis was evaluated by erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogue scale (VAS) before and after operation. The patients were followed up for 18 to 84 months. At the last follow-up, lumbar lordosis (LL), the Japanese Orthopaedic Association (JOA) score and imaging data were used to evaluate the recovery of spinal structure and function. There were no complications for all patients. During the follow-up of 3 to 12 months after operation, ESR and CRP returned to normal. The VAS score of local pain was significantly lower than that before operation ( p < 0.05). The LL and JOA scores of the patients at the last follow-up were significantly better than those before operation ( p < 0.05), and the lumbar CT and MR suggested the healing of vertebral lesions. PED and CLD might be an effective surgical treatment for spinal tuberculosis.
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Affiliation(s)
- Xun Zhang
- Department of Orthopedics, Pingchang People’s Hospital, China
| | - Keran Wang
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Xia
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiang Gao
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Du
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Liang Chen
- Department of Orthopedics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Xiong W, Yu B, Zhang Y, Wang C, Tang X, Cao H, Zhang X, Song Q, Tan F, Tan J. Minimally invasive far lateral debridement combined with posterior instrumentation for thoracic and lumbar tuberculosis without severe kyphosis. J Orthop Surg Res 2020; 15:221. [PMID: 32546172 PMCID: PMC7298961 DOI: 10.1186/s13018-020-01703-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 05/11/2020] [Indexed: 11/28/2022] Open
Abstract
Background Anti-tuberculous therapy (ATT) alone cannot easily cure spine tuberculosis (STB) though it is the most essential treatment. Many studies have confirmed the efficacy of the surgical treatment of STB through anterior, anterolateral, posterior debridement, and intervertebral fusion or combined with internal fixation. However, the conventional surgical approach requires extensive exposure of the affected areas with high rates of morbidity and mortality. Recently, minimally invasive surgery has come into use to reduce iatrogenic trauma and relevant complications. Here, we introduced a novel technique for the treatment of thoracic and lumbar spine tuberculosis: minimally invasive far lateral debridement and posterior instrumentation (MI-FLDPI). In this study, we evaluated the technical feasibility, the clinical outcomes, and the postoperative complications. Methods We did a prospective, non-randomized study on this new technique. Twenty three patients (13 males) with thoracic or lumbar spine tuberculosis who underwent minimally invasive far lateral debridement and posterior instrumentation were included in the study. The preoperative comorbidities, operation duration, intra-operative hemorrhage, Cobb’s angles, and postoperative complications were recorded and analyzed. Clinical outcomes were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological recovery, and eradication of tuberculosis. Radiological outcomes were evaluated by changes in Cobb’s angle and fusion status of the affected segments. Results The patients were followed for an average of 19 months (ranging from 12 to 36 months). At the final follow-up, CRP and ESR of all patients were normal. The VAS and ODI were significantly improved compared with preoperative values (P < 0.05). No evident progression of the kyphotic deformity was found after surgery. Twenty two patients showed spontaneous peripheral interbody fusion 1 year after surgery. There were no failure of the instrumentation even though a young female with drug-resistant tuberculosis showed no sign of interbody fusion at the third year follow-up. All the patients with preoperative neurological deficit showed complete recovery at the final follow-up. Conclusions MI-FLDPI using expandable tubular retractor could be recommended to treat thoracic and lumbar spine tuberculosis for the advantages of less trauma, earlier recovery, and less complications. Spontaneous peripheral interbody fusion was observed in nearly all the cases even without bone grafting.
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Affiliation(s)
- Wei Xiong
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Bing Yu
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Yao Zhang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Chunxiao Wang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Xiaojie Tang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Haifei Cao
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Xibing Zhang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Qinyong Song
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Fang Tan
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China
| | - Jiangwei Tan
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Yantai, 264000, Shandong, China.
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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
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Li TQ, Ma ZS, Zhang Y, Xu HF, Lei W. Therapeutic effect of minimally invasive catheter drainage and local chemotherapy for the lumbosacral tuberculosis without neural symptoms. Medicine (Baltimore) 2019; 98:e15941. [PMID: 31169716 PMCID: PMC6571358 DOI: 10.1097/md.0000000000015941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Increasing number of studies have shown growing incidence of lumbosacral tuberculosis and its complications. However, the treatment options for this disorder are still limited.To evaluate the long-term therapeutic effect and prognosis of minimally invasive puncture catheter drainage and Isoniazid local chemotherapy for the treatment of lumbosacral tuberculosis without neural symptoms under the guidance of computed tomography (CT).A total of 45 patients with asymptomatic lumbosacral tuberculosis were treated by minimally invasive catheter drainage under CT guidance. Forty-two cases had been followed up, which included 22 women and 20 men with an average age of 36.45 years old. Isoniazid was injected locally and antituberculotic drugs were administered for postoperative treatment. Oswestry Disability Index (ODI), visual analogue scale (VAS) evaluation and Cobb angle were recorded before and after operation.Forty-two patients had been followed up and the follow-up term was from 1.2 to 8.5 years (average 60 months). All patients were healed without recurrent cases. The ODI were improved from 14.86 ± 2.02 before operation to 1.48 ± 1.55 after operation. The post-operative (4.19 ± 1.17) VAS score was improved compared to the pre-operative VAS score (0.55 ± 0.55). The post-operative Cobb angle (6.19° ± 3.85°) was also improved relatively to the preoperative Cobb angle (5.90° ± 3.71°).Minimally invasive puncture catheter drainage combined with Isoniazid local chemotherapy is an effective method for lumbosacral tuberculosis without neural symptom. Meanwhile, it can be applied for the treatment of spinal tuberculosis before open surgery.
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Howie BA, Davidson IU, Tanenbaum JE, Pahuta MA, Buchholz AL, Steinmetz MP, Mroz TE. Thoracic Epidural Abscesses: A Systematic Review. Global Spine J 2018; 8:68S-84S. [PMID: 30574442 PMCID: PMC6295817 DOI: 10.1177/2192568218763324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Past research has demonstrated increased speed and severity of progression for spinal epidural abscesses (SEAs) of the thoracic level, specifically, when compared with SEAs of other spinal cord levels. Untreated, this infection can result in permanent neurological sequelae with eventual progression to death if inadequately managed. Despite the seriousness of this disease, no articles have focused on the presentation, diagnosis, and treatment of SEAs of the thoracic level. For this reason, specific focus on SEAs of the thoracic level occurred when researchers designed and implemented the following systematic review. METHODS A query of Ovid-Medline and EMBASE, Cochrane Central, and additional review sources was conducted. Search criteria focused on articles specific to thoracic epidural abscesses. RESULTS Twenty-five articles met inclusion criteria. The most commonly reported symptoms present on admission included back pain, paraparesis/paraplegia, fever, and loss of bowel/bladder control. Significant risk factors included diabetes, intravenous drug use, and advanced age (P = .001). Patients were most often treated surgically with either laminectomy, hemilaminectomy, or radical decompression with debridement. Patients who presented with neurological deficits and had delayed surgical intervention following a failed antibiotic course tended to do worse compared with their immediate surgical management counterparts (P < .005). CONCLUSIONS For the first time researchers have focused specifically on SEAs of the thoracic level, as opposed to previously published general analysis of SEAs as a whole. Based on the results, investigators recommend early magnetic resonance imaging of the spine, laboratory workup (sedimentation rate/C-reactive protein, complete blood count), abscess culture followed by empiric antibiotics, and immediate surgical decompression when neurological deficits are present.
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Affiliation(s)
- Benjamin A. Howie
- Cleveland Clinic, Cleveland, OH, USA
- Northeast Ohio Medical University, Rootstown, OH, USA
| | | | - Joseph E. Tanenbaum
- Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
| | | | | | | | - Thomas E. Mroz
- Cleveland Clinic, Cleveland, OH, USA
- Case Western Reserve University, Cleveland, OH, USA
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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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Zhang Y, Gu D, Ji D. The design and application of a customized navigation board for lumbar disc ablation. Comput Assist Surg (Abingdon) 2017; 22:305-311. [PMID: 29086599 DOI: 10.1080/24699322.2017.1389409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
PURPOSE This paper aimed to explore the design and application of a customized navigation board for lumbar disc ablation. METHODS Eight cases of lumbar disc herniation (diagnosed by spiral computerized tomography, CT) to be treated via intervertebral ablation using a path from the skin to the herniated intervertebral disc were included. The lumbar vertebrae, sacrum, and skin (adhered to a standard base, Figure 1) were reconstructed based on continuous spiral CT slices. The path was designed by the surgeon (Figure 2) to be line between the base and the puncture point, and was guided by the navigation board. The board was prototyped and used in ablation localization as a guide canal. The intra- and post-operative complications were recorded during the operation and 48-hours post operation, respectively. RESULTS In all eight cases, target discs were punctured after a duration ranging from 6 to 13 minutes. No complications were observed either during the operation or at 48 hours post-operatively. CONCLUSION This customized navigation board could promote the accuracy and diminish the duration of intervertebral disc ablation. A stereolithography apparatus (SLA) and photosensitive resin could generate a customized reverse guide board with high fidelity for intervertebral disc ablation. Manually performed rigid registration can meet the accuracy requirements. The results presented in the present paper demonstrated that rapid prototyping via an SLA and photosensitive resin could maintain the accuracy and dynamic stability of a customized navigation board for lumbar disc ablation.
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Affiliation(s)
- Yan Zhang
- a School of Optical-Electrical Computer Engineering , University of Shanghai for Science and Technology , Shanghai , China.,b Digital Medical Research Center , School of Basic Medical Sciences, Fudan University, Shanghai Key Laboratory of Medical Imaging Computing and Computer-Assisted Intervention , Shanghai , China
| | - Diebao Gu
- c Medical School of Nantong University , Nantong , Jiangsu Province , China
| | - Dafeng Ji
- c Medical School of Nantong University , Nantong , Jiangsu Province , China.,d Jiangsu Zouke Medical Instruments Ltd, Corp , Nantong , Jiangsu Province , China
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