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Arifin J, Biakto KT, Johan MP, Anwar SFZ. Clinical outcomes and surgical strategy for spine tuberculosis: a systematic review and meta-analysis. Spine Deform 2024; 12:271-291. [PMID: 37975989 PMCID: PMC10867033 DOI: 10.1007/s43390-023-00785-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE Spinal tuberculosis (TB) is a slow-developing disease that often causes cord compression, spinal instability, and deformity. Surgery is generally required in cases of refractory disease, severe kyphosis, neurological deficits, or lack of improvement. However, there is a lack of comprehensive evidence in comparing the efficacy of various surgical approaches. The study aims to provide a clearer understanding of the relative effectiveness of the available surgical modalities in the management of spinal TB. METHODS This review adhered to the PRISMA statement with searching conducted until 11th April 2023. Inclusion criteria included studies involving surgical procedures for spinal tuberculosis, with relevant clinical outcomes reported. Data extraction involved the collection of information on study and population characteristics, interventions used, relevant clinical outcomes, and reported complications. The risk of bias was evaluated using Cochrane's Risk of Bias in Non-randomized Studies tool. RESULTS Searching resulted in 20 cohort studies that analyzed surgical methods for spinal tuberculosis. Eleven studies had low bias and nine studies had moderate bias. The anterior approach was associated with faster perioperative duration [- 2.02 (- 30.71, 26.67), p < 0.00001], less blood loss [- 4242 (- 176.02, 91.18), p < 0.00001], shorter hospitalization [- 0.19 (- 2.39, 2.01), p < 0.00001], better angle correction [1.01 (- 1.82, 3.85), p < 0.00001], and better correction rates [11.36 (- 7.32, 30.04), p < 0.00001] compared to the posterior approach. Regarding neurological function recovery, the anterior and posterior approaches were equally effective, while the posterior approach was associated with a higher incidence of complications. The review also reported on the complications associated with the surgical approaches, and 9 out of 20 studies reported complications. The anterior approach was found to have fewer complications overall. CONCLUSION The anterior approach is thought to have fewer complications than both combined and posterior-only approaches, but the variability of the findings indicates that the decision-making process for selecting a surgical approach must consider individual patient and disease characteristics, as well as surgeon training.
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Affiliation(s)
- Jainal Arifin
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Karya Triko Biakto
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - Muhammad Phetrus Johan
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia
| | - St Fatimah Zahrah Anwar
- Department of Orthopaedics and Traumatology, Hasanuddin University, Jl. Perintis Kemerdekaan No. 10, Tamalanrea Indah, Makassar, Sulawesi Selatan, 90245, Indonesia.
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Xu Z, Wang X, Zhang Z. Long-segment versus short-segment fixation through a posterior approach for tuberculous spondylodiscitis of the mid-thoracic spine in adults: a study of mid- to long-term efficacy. J Neurosurg Sci 2023; 67:718-726. [PMID: 33709660 DOI: 10.23736/s0390-5616.21.05225-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This retrospective study aimed to perform a comparative evaluation of the mid- to long-term efficacy of long-segment and short-segment fixations via the posterior approach as a treatment for tuberculous spondylodiscitis in the mid-thoracic spine. METHODS A total of 95 patients with tuberculous spondylodiscitis in the mid-thoracic spine underwent surgery via the posterior approach including single-stage posterior debridement, interbody fusion, and pedicle screw fixation. Long-segment fixations were performed for 46 patients (group A), while short-segment fixations were performed for the other 49 patients (group B). Clinical and radiological outcomes were assessed during mid- to long-term follow-up. RESULTS The average follow-up periods for groups A and B were 75.5±11.8 and 76.8±11.6 months, respectively. The operative time and intraoperative blood loss were lower in group B than in group A (P<0.05). Both management approaches significantly corrected the kyphotic deformity detected either in the early postoperative period or at the final visit after long-term follow-up (P>0.05). Bony fusion was generated after average periods of 10.8±2.1 months and 11.0±2.0 months in groups A and B, respectively. Favorable outcomes were observed on assessment of neurological function and patients' well-being at the final follow-up. CONCLUSIONS No therapeutic differences were observed between long-segment and short-segment fixation as surgical treatment for mid-thoracic Pott's disease during mid- to long-term follow-up. Kyphotic deformity and neurological impairment were significantly relieved via both posterior fixation approaches, with patients' well-being reaching a favorable level. Moreover, short-segment fixation led to less blood loss and required a shorter operative time.
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Affiliation(s)
- Zhenchao Xu
- Department of Spine Surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China -
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China
| | - Zhen Zhang
- Department of Spine Surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China
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Zhong Y, Tang B, Zhang Z, Sheng Y, Li C, Guo J, Luo S, Yao H, Wan Z. Clinical efficacy and imaging analysis for the surgical treatment of thoracolumbar infections in elderly patients: a retrospective study. Sci Rep 2023; 13:10341. [PMID: 37365248 DOI: 10.1038/s41598-023-36985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/13/2023] [Indexed: 06/28/2023] Open
Abstract
Few reports have been conducted to comparing surgical results and safety evaluations between the different types of infections in geriatric patients with thoracolumbar infections. The aim of this study is to investigate the safety and efficacy of surgical treatment for thoracolumbar infections in elderly patients. 21 patients with pyogenic spondylodiscitis (PS) and 26 patients with tuberculous spondylodiscitis (TS) were enrolled in the study. All patients were treated using one-stage posterior debridement, decompression, and pedicle screw fixation. Comparison of operative safety parameters between the two groups. Clinical efficacy was evaluated using visual analogue scale (VAS) score, the American Spinal Injury Association (ASIA) grade, the short form (SF)-36 survey and Oswestry disability index (ODI) to determine patient quality of life pre- and post-operatively. Hospitalisation and intensive care unit duration in the PS group were significantly shorter than in the TS group (P < 0.05). The total incidence of post-operative complications for both groups was 44.7%. More complications occurred in the TS group, but the difference was not significant. The scores of VAS, ODI and SF-36 of all 47 patients were significantly improved compared with those before operation.The VAS and SF-36 scores (physical component) were significantly better in the PS group 6 months post-operatively, and the SF-36 (mental component) scores were significantly better in the PS group at the 1-year follow-up. Neurological status in both groups improved post-operatively, and 83% of patients reported satisfactory results based on the modified MacNab standard. Imaging results showed that bone graft fusion improved in both groups at 6 months, 1 year and at the final follow-up. One-stage posterior debridement, decompression, interbody fusion, and internal fixation can be considered a safe and effective method of treating spinal infections in the elderly. This method can improve nerve function, reconstruct spinal stability, and enhance the quality of life of elderly patients. Both PS and TS who underwent surgery achieve similar clinical and radiological results.
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Affiliation(s)
- Yanlong Zhong
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Benyu Tang
- Department of Orthopedics, The People's Hospital of Yi Chun City, Yichun, 336000, Jiangxi, People's Republic of China
| | - Zizhen Zhang
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Yonghong Sheng
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Chao Li
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Jia Guo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Shiwei Luo
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Haoqun Yao
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China
| | - Zongmiao Wan
- Department of Orthopedics, The First Affiliated Hospital of Nanchang University, 17 Yongwai Street, Nanchang, 330006, Jiangxi, People's Republic of China.
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Xu Z, Zhang Z, Wu Y, Wang X. Posterior transforaminal debridement and interbody fusion with instrumentation for multi-segment thoracic spinal tuberculosis: a midterm follow-up study. Sci Rep 2022; 12:18244. [PMID: 36309556 PMCID: PMC9617847 DOI: 10.1038/s41598-022-23169-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/26/2022] [Indexed: 12/31/2022] Open
Abstract
This retrospective study aimed to evaluate midterm outcomes of surgical management of multi-segment thoracic spinal tuberculosis by single-stage posterior transforaminal debridement and interbody fusion with instrumentation. From January 2007 to October 2015, 42 adult patients with thoracic spinal tuberculosis involving three or more levels underwent single-stage posterior transforaminal debridement, interbody fusion and instrumentation At a mean follow-up of 73.5 ± 9.6 months, all patients were eligible for final evaluation. All displayed improved biochemical markers and pain scores at 3 months and improved physiologic levels at the end of treatment. Visual analogue and 36-Item Short-Form Health Survey scores were significantly improved compared with preoperative values. All 30 patients with preoperative neurological deficits experienced neurologic improvement. Thoracic kyphosis angle decreased significantly from 34.4° ± 4.5° to 22.0° ± 2.6°. A mean kyphotic angle loss of 1.7° ± 1.1° was recorded at the final follow-up, and bone fusion was observed at a mean of 10.6 ± 2.1 months, with no instrumentation failures. One patient experienced delayed incisional healing and five patients suffered postoperative intercostal neuralgia that were cured by conservative treatment. There were no graft failures or implant breakages. This study showed the utility of a single-staged procedure combining posterior transforaminal debridement and interbody fusion with instrumentation, and demonstrated promising results.
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Affiliation(s)
- Zhenchao Xu
- grid.452223.00000 0004 1757 7615Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008 Hunan China ,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008 Hunan China
| | - Zhen Zhang
- grid.452223.00000 0004 1757 7615Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008 Hunan China ,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008 Hunan China
| | - Yunqi Wu
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008 Hunan China
| | - Xiyang Wang
- grid.452223.00000 0004 1757 7615Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, 410008 Hunan China ,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, 410008 Hunan China
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Xu Z, Wang X, Zhang Z, Jiang D, Jia R, Zhang Y. A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study. BMC Musculoskelet Disord 2022; 23:590. [PMID: 35717155 PMCID: PMC9206337 DOI: 10.1186/s12891-022-05539-8] [Citation(s) in RCA: 3] [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: 02/11/2022] [Accepted: 06/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background This retrospective observational study was conducted to compare midterm outcomes of three bone graft struts for interbody fusion using a posterior approach in adults with lower lumbar spinal tuberculosis. Methods A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Forty-one patients (group A) were treated with autogenous bone graft for interbody fusion, 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. In addition, clinical and radiographic data were gathered and analyzed. Results At the final follow-up, all patients were completely cured. The operation period and intraoperative blood loss for groups B and C were significantly less than in group A (P = 0.000). Post-operation, neurological performance and quality of life were remarkably improved at the final follow-up. The preoperative lordosis angles of three groups were significantly improved, as evidenced by the values immediately after the operation or those at the final follow-up. The correction loss of the group C was lower than those of groups A and B (P = 0.000). All the patients obtained bone graft fusion, the fusion period of group B was longer than that of the other two groups (P = 0.000). No significant differences among the three groups in adjacent segment degeneration rates were found at the last visit (P = 0.922). Conclusions This midterm follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation, combined with medical therapy, can effectively treat lower lumbar spinal tuberculosis. In addition, the intervertebral titanium mesh cage bone graft can provide better outcomes with regard to maintaining lordosis and preventing collapse. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05539-8.
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Affiliation(s)
- Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.
| | - Zhen Zhang
- Department of Spine Surgery and Orthopaedics, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
| | - Dingyu Jiang
- Department of Spine Surgery and Orthopaedics, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
| | - Runze Jia
- Department of Spine Surgery and Orthopaedics, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
| | - Yilu Zhang
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China
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Librianto D, Hadisoebroto Dilogo I, Fauzi Kamal A, Saleh I, Ipang F, Aprilya D. Effectiveness of Kyphosis Reduction Using Cantilever Method in Thoracolumbar Spondylitis Tuberculosis: A Short-Term Follow-Up. Orthop Res Rev 2021; 13:275-280. [PMID: 34887687 PMCID: PMC8651210 DOI: 10.2147/orr.s342365] [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] [Received: 10/22/2021] [Accepted: 11/25/2021] [Indexed: 11/23/2022] Open
Abstract
Background Kyphosis in spondylitis tuberculosis (STb) is more than just a cosmetic issue. It has a potentially detrimental effect on both spine-associated structures and cardiopulmonary function. It can be corrected in any stage of STb; however, the corrective surgery is challenging, especially in the late case, in which the additional stiffness of the spine can come into consideration. To date, the cantilever technique is still a gold standard for sagittal plane deformity correction. However, no study to date has explored its effectiveness for thoracolumbar kyphotic deformity, especially that caused by spondylitis tuberculosis. Methods This is a retrospective study of 16 consecutive cases of spondylitis tuberculosis with thoracolumbar kyphosis that underwent corrective surgery in our center in the period of 2020–2021. We aim to evaluate the effectiveness of the cantilever technique that we use for kyphotic correction in thoracolumbar STb patients. Results At the 3-months follow-up, the mean Cobb angle was 14.6°±10.27°, with the mean gain of 20.90°±12.00° and positively correlate with the thoracolumbar kyphosis (TLK) correction (68.69%, r = 0.654, p = 0.001). The mean thoracic kyphosis, lumbar lordosis, and sagittal vertebral axis were 30.6°±13.08°, 39.4°±16.02°, and 1.4±4.09 cm, respectively, with sagittal Cobb difference of 12.70±9.85. Conclusion The kyphotic Cobb angle reduction by cantilever technique in the thoracolumbar area significantly improved the thoracolumbar kyphosis and realign the spinal sagittal axis. Thus, the cantilever technique remains the gold standard for sagittal plane deformity correction which can be applied for kyphotic deformity correction in thoracolumbar STb cases.
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Affiliation(s)
- Didik Librianto
- Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia
| | - Ismail Hadisoebroto Dilogo
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Achmad Fauzi Kamal
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ifran Saleh
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Fachrisal Ipang
- Orthopedic Spine Surgeon, Fatmawati General Hospital, Jakarta, Indonesia
| | - Dina Aprilya
- Department of Orthopedic and Traumatology, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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Cantilever method for severe kyphotic deformity correction in spondylitis tuberculosis: A technical note and literature review. Ann Med Surg (Lond) 2021; 69:102764. [PMID: 34484731 PMCID: PMC8405960 DOI: 10.1016/j.amsu.2021.102764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background The kyphotic deformity is more than just a cosmetic disfigurement. It is potentially life-threatening and disturbs the quality of life by causing cardiopulmonary dysfunction, spinal imbalance, and other associated problems. Corrective surgery is challenging but it is needed to bring the spinal balance back thus halting the progressiveness of the deformity. The cantilever technique is a gold standard to correct the sagittal plane deformity. Methods This is a review article with some case illustrations from Author's experience. Objective We aim to review the cantilever technique for kyphotic correction in spondylitis tuberculosis patients. Conclusion The cantilever technique is the standard for sagittal plane deformity correction that can be applied for kyphotic deformity correction in spondylitis tuberculosis cases. Developing the safest techniques and instrumentation is crucial to achieving spinal balance with minimal risk of morbidities. Kyphotic deformity is more than just a cosmetic problem. Kyphotic deformity is potentially life-threatening and disturbs quality of life. Deformity correction surgery is challenging. Cantilever technique is a gold standard to correct sagittal plane deformity.
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Zhuang QK, Li W, Chen Y, Bai L, Meng Y, Li Y, Gu YT. Application of Oblique Lateral Interbody Fusion in Treatment of Lumbar Spinal Tuberculosis in Adults. Orthop Surg 2021; 13:1299-1308. [PMID: 33955680 PMCID: PMC8274156 DOI: 10.1111/os.12955] [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: 06/05/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of the present paper was to evaluate the safety and clinical efficacy of mini-open retroperitoneal oblique lumbar interbody fusion (OLIF) for the treatment of lumbar spinal tuberculosis. METHODS A total of 115 patients who suffered from lumbar spinal tuberculosis from June 2014 to December 2017 were included in this research. A total of 59 patients underwent OLIF and percutaneous pedicle screw fixation (OLIF group) and 56 patients underwent the anterior-only approach (anterior-only group). All patients were followed up for at least 24 months. Operation time, blood loss, and rate of complications were used to assess the safety of these two techniques. The visual analog scale (VAS) and the Oswestry disability index (ODI) were used to evaluate the relief of neurological and functional symptoms. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured to investigate the activity and recurrence of spinal tuberculosis. The Cobb angle, the sagittal vertical axis of the spine (SVA), the pelvic tilt (PT), the sacral slope (SS), the pelvic incidence (PI), and postoperative Frankel classification were also used to assess the efficiency of the spine deformity correction and the recovery of long-term neurological function. RESULTS Most patients were successfully treated with OLIF and the anterior-only technique and attained satisfactory clinical efficiency during the 24-month follow-up period. In the perioperative period, the mean operative time (154.68 ± 23.64 min, P < 0.001), the mean blood loss (110.57 ± 87.67 mL, P < 0.001), and the mean hospital stay (9.55 ± 3.62 days, P < 0.001) of the OLIF group were all significantly lower than in the anterior-only group (172.49 ± 25.67 min, 458.56 ± 114.89 mL, and 14.89 ± 3.89 days, respectively). A total of 10 patients (16.95%) experienced complications in the OLIF group, including neurological injury, segmental artery and iliac vein lacerations, peritoneal injury, instrument failure, and infection of incisions; this rate of complications was lower than in the anterior-only group (37.50%, P = 0.013). Regard to spinal deformity correction, the Cobb angle (9.42° ± 1.72°, P = 0.032), the SVA (2.23 ± 1.07 cm, P = 0.041), the PT (14.26° ± 2.37°, P = 0.037), and the SS (39.49° ± 2.17°, P = 0.042) of the OLIF group at last follow-up were all significantly different when compared to the anterior-only group (14.75° ± 2.13°, 3.48 ± 0.76 cm, 18.58° ± 1.45°, and 36.78° ± 1.96°, respectively). The VAS and the ODI of the OLIF group at 1 week postoperatively (3.15 ± 0.48, 21.85 ± 3.78, P = 0.032, 0.037) and at the last follow-up (2.12 ± 0.35, 16.70 ± 5.25, P = 0.043, 0.035) were both lower than for the anterior-only group (5.18 ± 0.56, 29.83 ± 5.42 and 3.67 ± 0.62, 20.68 ± 6.23). The Frankel classification was improved for both OLIF and anterior-only patients; however, there were 35 cases (59.32%) classified as Frankel grade E in the OLIF group and 22 cases (39.29%, P = 0.021) in the anterior-only group CONCLUSION: The OLIF surgical technique for single lumbar (L2 -L5 ) spinal tuberculosis is less invasive, has lower complication rates, and is more efficient than the anterior-only approach. However, the long-term effects of this surgical technique still need to be explored.
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Affiliation(s)
- Quan-Kui Zhuang
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Wei Li
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Yong Chen
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Liang Bai
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Yong Meng
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Yang Li
- Department of Orthopaedic Surgery, No. 2 People's Hospital of Fu Yang, Fuyang, China
| | - Yu-Tong Gu
- Department of Orthopaedic Surgery, Zhongshan Hospital Fudan University, Shanghai, China.,Department of Orthopaedic Surgery, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 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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Xu Z, Wang X, Liu Z. One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up. J Orthop Surg Res 2020; 15:473. [PMID: 33054798 PMCID: PMC7557076 DOI: 10.1186/s13018-020-02005-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 10/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background To evaluate the mid-long-term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) in adults by one-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion. Methods A total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion was performed. Clinical and radiographic outcomes were compared and analyzed. Results All patients were followed-up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4° to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found. Conclusions One-stage posterior debridement, single-segment fixation, and titanium mesh cage interbody fusion represent effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. This approach may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimal invasiveness and rapid postoperative rehabilitation.
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Affiliation(s)
- Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China.
| | - Zheng Liu
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Central South University, Changsha, China
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Wu W, Yang S, Wang C, Lyu J, Liu X, Zhang Z, Xu J, Luo F. Treatment of lumbosacral tuberculosis by anterior internal fixation combined with computed tomography angiography. J Orthop Surg (Hong Kong) 2020; 27:2309499019874876. [PMID: 31554492 DOI: 10.1177/2309499019874876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE This study aims to examine the iliac vascular space in patients with lumbosacral tuberculosis and to evaluate the feasibility of anterior internal fixation for lumbosacral tuberculosis. METHODS A retrospective analysis was performed in 36 patients with lumbosacral tuberculosis. The preoperative three-dimensional computed tomography angiography images were analyzed for anatomical parameters. RESULTS There were large variations among the anterior lumbosacral iliac vessels. Predominantly, the left iliac vein and the right iliac artery formed the two borders of the triangular iliac vascular space in the coronal plane. The mean distance between the iliac vessels straddle point and the inferior endplate of L5 was 15.01 ± 15.08 mm. In the sagittal plane, presacral abscess increased the distance between the posterior iliac vessel and the anterior vertebra. The distances on the left and right sides were 9.94 ± 6.03 and 10.15 ± 5.46 mm, respectively, at the inferior endplate of L5 and were 11.90 ± 6.97 and 11.68 ± 5.52 mm, respectively, at the superior endplate of S1. CONCLUSIONS The space on sagittal plane occupied by presacral abscess may push forward the vessels and therefore provide opportunities for anterior internal fixation.
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Affiliation(s)
- Wenjie Wu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Sen Yang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Cheng Wang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jingtong Lyu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xun Liu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zehua Zhang
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Fei Luo
- Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, China
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Liu Z, Zhang P, Li W, Xu Z, Wang X. Posterior-only vs. combined posterior-anterior approaches in treating lumbar and lumbosacral spinal tuberculosis: a retrospective study with minimum 7-year follow-up. J Orthop Surg Res 2020; 15:99. [PMID: 32156304 PMCID: PMC7063822 DOI: 10.1186/s13018-020-01616-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is no comparative study with long-term follow-up between posterior-only and combined posterior-anterior approaches in treating lumbar spinal tuberculosis (LSTB) and lumbosacral spinal tuberculosis (LSSTB). This retrospective study aimed to compare and evaluate the long-term outcomes of these two surgical approaches in LSTB and LSSTB. METHODS Thirty patients with LSTB and 12 patients with LSSTB underwent posterior-only approach (group A); 26 patients with LSTB and 14 patients with LSSTB were managed with combined posterior-anterior approaches (group B). Analysis and comparison in clinical and radiographic outcomes between the two groups were performed. RESULTS The intra-operative bleeding amount, surgery time, and hospitalization days in group A were less than that in group B (P < 0.05). These patients were followed for a minimum of 7 years. All patients achieved completely healing within 2-year follow-up. Bony fusion was obtained in all patients. The visual analog scale, Japanese Orthopedic Association score, Oswestry Disability index, and Kirkaldy-Willis functional evaluation at the final visit demonstrated that all patients in both groups achieved satisfactory results. There was no significant difference in angle correction or maintaining correction between combined posterior-anterior approaches and posterior-only approach (P > 0.05). Complications occurred in both groups. CONCLUSIONS Both combined posterior-anterior approaches and posterior-only approach can achieve satisfactory clinical and radiological outcomes of long-term in treating LSTB and LSSTB, while posterior-only approach can safely and effectively achieve lesion debridement, decompression, and stability reconstruction and maintenance with the advantages of less invasive surgery, less bleeding, shorter surgery time, and hospital stay, and fewer complications. So, posterior-only approach seemed to be superior to the combined posterior-anterior one.
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Affiliation(s)
- Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Penghui Zhang
- The Orthopedics Department, the Seventh Affiliated Hospital, Sun Yat-sen University, 628#Zhenyuan Road, Zhenmei Community, Guangming District, Shenzhen, 518107, Guangdong, People's Republic of China
| | - Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Zhengchao Xu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
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Liu Z, Li W, Xu Z, Wang X, Zeng H. One-stage posterior debridement, bone grafting fusion, and mono-segment vs. short-segment fixation for single-segment lumbar spinal tuberculosis: minimum 5-year follow-up outcomes. BMC Musculoskelet Disord 2020; 21:86. [PMID: 32033563 PMCID: PMC7007649 DOI: 10.1186/s12891-020-3115-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To compare the clinical and radiological outcomes between posterior mono-segment and short-segment fixation combined with one-stage posterior debridement and bone grafting fusion in treating single-segment lumbar spinal tuberculosis (LSTB). METHODS Sixty-two patients with single-segment LSTB treated by a posterior-only approach were divided into two groups: short-segment fixation (Group A, n = 32) and mono-segment fixation (Group B, n = 30). The clinical and radiographic outcomes were analyzed and compared between the two groups. RESULTS The intraoperative bleeding volume, operation time, and hospitalization duration were lower in Group B than in Group A. All patients achieved the bony fusion criteria. The visual analog scale score, Japanese Orthopedic Association score, and Oswestry Disability Index were substantially improved 3 months postoperatively and at the last visit in both groups, with no significant difference between the two groups (P > 0.05). Kirkaldy-Willis functional evaluation at the final follow-up demonstrated that all patients in both groups achieved excellent or good results. The difference in the angle correction rate and correction loss between Groups A and B was not significant (P > 0.05). CONCLUSIONS One-stage posterior debridement, bone grafting fusion, and mono-segment or short-segment fixation can provide satisfactory clinical and radiological outcomes. Mono-segment fixation is more suitable for the treatment of single-segment LSTB because the lumbar segments with normal motion can be preserved with less trauma, a shorter operation time, shorter hospitalization, and lower costs.
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Affiliation(s)
- Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Zhengchao Xu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
- Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, People's Republic of China.
| | - Hao Zeng
- Department of Spinal Surgery, the First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Rd, Nanning, 530021, Guangxi, China
- Guangxi Key Laboratory of Regenerative Medicine, Nanning, 530021, Guangxi, China
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Liao Y, Ye R, Tang Q, Tang C, Ma F, Luo N, Zhong D. Is It Necessary to Perform the Second Surgery Stage of Anterior Debridement in the Treatment of Spinal Tuberculosis? World Neurosurg 2019; 134:e956-e967. [PMID: 31756501 DOI: 10.1016/j.wneu.2019.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this retrospective comparative study, the efficacy and clinical outcomes of long posterior instrumentation, with or without laminectomy, were evaluated and the necessity of the second stage of anterior debridement in the treatment of spinal tuberculosis (TB) was discussed. METHODS This retrospective study included 41 patients who were diagnosed with spinal TB between January 2010 and June 2016. A total of 18 patients had received long posterior instrumentation, with or without laminectomy (group A), whereas the other 23 patients had posterior instrumentation plus anterior debridement and autogenous bone grafting (group B). The surgical information, clinical effectiveness, laboratory tests, and imaging results were compared between the 2 groups. RESULTS One patient in group B died. Sinus drainage and incomplete bone fusion were discovered 1 year postoperatively. TB symptoms were significantly improved after surgery compared with those before surgery (P < 0.05), and there was no significant difference in the treatment efficacy between the 2 groups at the final follow-ups (P > 0.05). Compared with those of group B, the surgical time, bed-rest time, and hospitalization time of group A were all significantly shorter (P < 0.05), whereas the times before abscesses disappeared, bone graft fusion, and erythrocyte sedimentation rate returning to normal were all significantly longer (P < 0.05). CONCLUSIONS Single-stage long posterior instrumentation, with or without laminectomy, is a safe, effective, and feasible method for the treatment of spinal TB. The second stage of anterior debridement surgery may not be necessary for every spinal TB treatment.
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Affiliation(s)
- Yehui Liao
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rupei Ye
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiang Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chao Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Ma
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ning Luo
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Dejun Zhong
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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Bian Z, Gui Y, Feng F, Shen H, Lao L. Comparison of anterior, posterior, and anterior combined with posterior surgical treatment of thoracic and lumbar spinal tuberculosis: a systematic review. J Int Med Res 2019; 48:300060519830827. [PMID: 30880540 PMCID: PMC7581984 DOI: 10.1177/0300060519830827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background This study was performed to compare different surgical approaches in the treatment of spinal tuberculosis. Methods We conducted a literature search to identify and analyze papers published from January 1966 to April 2018 relevant to comparison of the anterior, posterior, and anterior combined with posterior approaches in the treatment of spinal tuberculosis of the thoracic and lumbar regions. Results Twenty-five studies involving 2295 patients were identified in this systematic review. The operative time was significantly longer in the anterior combined with posterior approach than in the other two approaches. Blood loss was significantly greater in the anterior combined with posterior approach (1125.0 ± 275.5 mL) than in the posterior approach (710.4 ± 192.4 mL). The difference in correction of the kyphosis angle among the three procedures was not significant. The overall surgical and transthoracic complications were significantly lower in the posterior approach. The clinical outcome of all patients improved, but there was no significant difference among the three procedures. Conclusions Blood loss, overall surgical and transthoracic complications, and the operative time are different among the three approaches. Therefore, different factors must be carefully assessed in deciding among the three procedures.
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Affiliation(s)
- Zhouliang Bian
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiding Gui
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fan Feng
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hongxing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lifeng Lao
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zhang J, Wu X, Lu T, Song H, Zhou Z, Li B. [Application of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:296-301. [PMID: 30874384 PMCID: PMC8337913 DOI: 10.7507/1002-1892.201809090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/28/2019] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis. Methods Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion. Results The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002). Conclusion One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.
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Affiliation(s)
- Jin Zhang
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Xinglin Wu
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Tingsheng Lu
- Department of Spinal Surgery, Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Hui Song
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Zhuojia Zhou
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002,
| | - Bo Li
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
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Short to Mid-Term Term Surgical Outcome Study with Posterior Only Approach on Tuberculous Spondylodiscitis in an Elderly Population. Asian Spine J 2016; 10:258-66. [PMID: 27114766 PMCID: PMC4843062 DOI: 10.4184/asj.2016.10.2.258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/09/2015] [Accepted: 08/09/2015] [Indexed: 11/08/2022] Open
Abstract
Study Design Retrospective study. Purpose To study short to mid-term outcome of surgically managed elderly patients of tuberculous spondylodiscitis with posterior only approach in terms of decision making and challenges in treatment, choice of implants and outcomes. Overview of Literature Tuberculous spondylodiscitis in the elderly is increasing due to longer survival rates. It presents with varied clinical manifestations needing surgical management. Management in tuberculous spondylodiscitis has been scarcely reported in the elderly, with a paucity of data on the choice of implants and approach. Methods Sixteen patients (five males, 11 females) older than 70-years-of-age culture and/or histopathology proven tuberculous spondylodiscitis were included in the study. All patients were operated using a single posterior approach. Pedicle screw with rods (PS/rods) or spinal loop with sublaminar wires (SL/SLW) were used for fixation. Clinical and surgical details were recorded. Sagittal correction achieved postoperatively and loss of correction at follow-up were noted. Results The mean age was 73.6 years (range, 70 to 80 years). The mean follow up was 44.5 months (range, 24 to 84 months). The mean immediate postoperative correction of sagittal deformity was 11.3 degrees; this correction was lost by a mean of 3.1 degrees at last follow-up. All 10 patients with deficit showed neurological recovery and all but one of the seven non-walkers were capable of independent ambulation at follow-up. Patients with SL/SLW and PS/rods had similar radiological outcome at final follow up. Conclusions Operative management gives satisfactory results in elderly patients with tuberculous spondylodiscitis. The posterior approach provides adequate exposure for decompression and rigid fixation, providing satisfactory clinical and radiological outcomes. SSL/SLW and pedicle screw rod construct both give similar radiological results if used appropriately in patients.
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