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Kang J, Xia X, Shang R, Wang X, Cao P, Wang J, Zhang J, Feng W, Wei J, Hu Q. Bilateral Endoscopic Debridement Combined with Local Antituberculosis Drugs for Thoracic Tuberculosis with Large Paravertebral Abscess: A Multicenter Study with 4-year Follow-Up. World Neurosurg 2024; 185:e1160-e1168. [PMID: 38499243 DOI: 10.1016/j.wneu.2024.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/09/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Paravertebral abscess represents a prevalent manifestation of thoracic tuberculosis, often necessitating surgical intervention. In this study, we introduced a novel approach by employing bilateral endoscopic debridement (BED) to address large Paravertebral abscesses associated with thoracic tuberculosis, a method not previously proposed in the literature. The clinical efficacy was examined through a comprehensive 4-year follow-up. METHODS We conducted a retrospective analysis on patients diagnosed with thoracic tuberculosis and paravertebral abscess who underwent BED combined with local antituberculosis drugs (BED + LAD) between February 2015 and February 2019. A total of 29 eligible patients (12 males and 17 females) with a median (interquartile ranges) of 59.0(16.5) years were included in the study. All patients received the BED + LAD treatment. After the surgery, the patients were treated with a 4-drug antituberculosis therapy (Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol). All relevant indicators were meticulously recorded and analyzed. RESULTS The surgical procedures were successfully completed for all subjects, with an average intraoperative bleeding volume of (25.2 ± 8.9) ml, an average surgical time of (68.4 ± 14.0) minutes, an average fluoroscopy frequency of (21.7 ± 8.2) times, an average hospital stay of (14.2 ± 4.3) days, and an average medication period of (42.1 ± 9.6) weeks. All subjects completed at least a 4-year follow-up period. At the final follow-up, ESR and CRP levels returned to normal, and there was no significant increase in the Cobb angle (P>0.05). CONCLUSIONS The application of BED + LAD in the treatment of thoracic tuberculosis and paravertebral abscess proved to be a safe, effective, and feasible approach.
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Affiliation(s)
- Jian Kang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiujia Xia
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Rong'an Shang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Xiaoming Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Panju Cao
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Junfeng Wang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jie Zhang
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Wanli Feng
- Spine Medicine Center, Baoji Traditional Chinese Medicine Hospital, Bao Ji, Shaanxi, China
| | - Jianmin Wei
- Minimally Invasive Spine Department, Xi'an International Medical Center Hospital, Xi'an, Shaanxi, China
| | - Qiaolong Hu
- First Department of Orthopedics, Yulin Second Hospital, Yu Lin, Shaanxi, China.
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Masuda S, Shimizu T, Sono T, Tamaki Y, Onishi E, Takemoto M, Odate S, Kimura H, Izeki M, Tomizawa T, Tsubouchi N, Fujibayashi S, Otsuki B, Murata K, Matsuda S. Recurrence rate after posterior percutaneous screw fixation without anterior debridement for pyogenic spondylitis compared with conservative treatment: a propensity score-matched analysis. 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; 32:4265-4271. [PMID: 37278875 DOI: 10.1007/s00586-023-07800-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/03/2023] [Accepted: 05/26/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Previous studies have shown that percutaneous pedicle screw (PPS) posterior fixation without anterior debridement for pyogenic spondylitis can improve patient quality of life compared with conservative treatment. However, data on the risk of recurrence after PPS posterior fixation compared with conservative treatment is lacking. The aim of this study was to compare the recurrence rate of pyogenic spondylitis after PPS posterior fixation without anterior debridement and conservative treatment. METHODS The study was conducted under a retrospective cohort design in patients hospitalized for pyogenic spondylitis between January 2016 and December 2020 at 10 affiliated institutions. We used propensity score matching to adjust for confounding factors, including patient demographics, radiographic findings, and isolated microorganisms. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for recurrence of pyogenic spondylitis during the follow-up period in the matched cohort. RESULTS 148 patients (41 in the PPS group and 107 in the conservative group) were included. After propensity score matching, 37 patients were retained in each group. PPS posterior fixation without anterior debridement was not associated with an increased risk of recurrence compared with conservative treatment with orthosis (HR, 0.80; 95% CI, 0.18-3.59; P = 0.77). CONCLUSIONS In this multi-center retrospective cohort study of adults hospitalized for pyogenic spondylitis, we found no association in the incidence of recurrence between PPS posterior fixation without anterior debridement and conservative treatment.
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Affiliation(s)
- Soichiro Masuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
| | - Takayoshi Shimizu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Sono
- Department of Orthopaedic Surgery, Fukui Red Cross Hospital, Fukui, Japan
| | - Yasuyuki Tamaki
- Department of Orthopaedic Surgery, Wakayama Red Cross Hospital, Wakayama, Japan
| | - Eijiro Onishi
- Department of Orthopaedic Surgery, Kobe Central General Hospital, Kobe, Japan
| | - Mitsuru Takemoto
- Department of Orthopaedic Surgery, Kyoto City Hospital, Kyoto, Japan
| | - Seiichi Odate
- Department of Orthopaedic Surgery, Gakkentoshi Hospital, Kyoto, Japan
| | - Hiroaki Kimura
- Department of Orthopaedic Surgery, Hyogo Prefectural Amagasaki General Medical Center, Hyogo, Japan
| | - Masanori Izeki
- Department of Orthopaedic Surgery, Kansai Electric Power Hospital, Osaka, Japan
| | - Takuya Tomizawa
- Department of Orthopaedic Surgery, Tenri Hospital, Nara, Japan
| | - Naoya Tsubouchi
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shunsuke Fujibayashi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Bungo Otsuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Murata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Tani Y, Saito T, Taniguchi S, Ishihara M, Paku M, Adachi T, Ando M, Kotani Y. A New Treatment Algorithm That Incorporates Minimally Invasive Surgery for Pyogenic Spondylodiscitis in the Thoracic and Lumbar Spines: The Results of Its Clinical Application to a Series of 34 Patients. Medicina (B Aires) 2022; 58:medicina58040478. [PMID: 35454317 PMCID: PMC9025525 DOI: 10.3390/medicina58040478] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022] Open
Abstract
Background and Objectives: Spinal minimally invasive surgery (MIS) experts at the university hospital worked as a team to develop a new treatment algorithm for pyogenic spondylodiscitis in lumbar and thoracic spines. They modified a flow chart introduced for this condition in a pre-MIS era to incorporate MIS techniques based on their extensive experiences accumulated over the years, both in MIS for degenerative lumbar diseases and in the treatment of spine infections. The MIS procedures incorporated in this algorithm consisted of percutaneous pedicle screw (PPS)–rod fixation and transpsoas lateral lumbar interbody fusion (LLIF). The current study analyzed a series of 34 patients treated with prospective selection of the methods according to this new algorithm. Materials and Methods: The algorithm first divided the patients into those who had escaped complicated disease conditions, such as neurologic impairment, extensive bone destruction, and the need to be mobilized without delay (Group 1) (19), and those with complicated pyogenic spondylodiscitis (Group 2) (15). Group 1 had image-guided needle biopsy followed by conservative treatment alone with antibiotics and a spinal brace (12) (Group 1-A) or a subsequent addition of non-fused PPS–rod fixation (7) (Group 1-B). Group 2 underwent an immediate single-stage MIS with non-fused PPS–rod fixation followed by posterior exposure for decompression and debridement through a small midline incision (12) (Group 2-A) or an additional LLIF procedure after an interval of 3 weeks (3) (Group 2-B). Results: All patients, except four, who either died from causes unrelated to the spondylodiscitis (2) or became lost to follow up (2), were cured of infection with normalized CRP at an average follow up of 606 days (105–1522 days). A solid interbody fusion occurred at the affected vertebrae in 15 patients (50%). Of the patients in Group 2, all but two regained a nearly normal function. Despite concerns about non-fused PPS–rod instrumentation, only seven patients (21%) required implant removal or replacement. Conclusions: Non-fused PPS–rod placements into infection-free vertebrae alone or in combination with posterior debridement through a small incision worked effectively in providing local stabilization without contamination of the metal implant from the infected tissue. MIS LLIF allowed for direct access to the infected focus for bone grafting in cases of extensive vertebral body destruction.
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Affiliation(s)
- Yoichi Tani
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
- Correspondence: ; Tel.: +81-72-804-2439
| | - Takanori Saito
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Shinichiro Taniguchi
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Masayuki Ishihara
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Masaaki Paku
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Takashi Adachi
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Muneharu Ando
- Department of Orthopaedic Surgery, Kansai Medical University, 2-5-1 Shinmachi, Hirakata 573-1010, Japan; (T.S.); (S.T.); (M.I.); (M.P.); (T.A.); (M.A.)
| | - Yoshihisa Kotani
- Department of Orthopaedic Surgery, Kansai Medical University Medical Center, 10-15 Fimizono-cho, Moriguchi 570-8507, Japan;
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Deng L, Zhang YW, Xiong LY, Zhang SL, Ni WY, Xiao Q. Extreme lateral interbody fusion and percutaneous pedicle screw fixation in the minimally invasive treatment of thoracic tuberculosis. J Int Med Res 2021; 48:300060520925992. [PMID: 32459154 PMCID: PMC7278100 DOI: 10.1177/0300060520925992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE As a minimally invasive intervertebral fusion technique popularized in recent years, extreme lateral interbody fusion (XLIF) has various advantages. In this study, we describe the application and efficacy of XLIF for the treatment of thoracic tuberculosis (TB), as this may be an emerging treatment option for thoracic TB in the future. METHODS We present the case of a 75-year-old man who had suffered from chest and back pain for 1 month. Imaging studies showed destruction of the T12 and L1 vertebral bodies and the T12-L1 intervertebral disc, accompanied by formation of a paravertebral abscess. After 2 weeks of standard anti-TB treatment, the patient underwent debridement of the lesions, XLIF, and percutaneous pedicle screw fixation. RESULTS The patient's chest and back pain were significantly alleviated after the operation. The patient recovered well, and as of the most recent follow-up had no obvious limitation in thoracolumbar spine function. CONCLUSIONS XLIF combined with percutaneous pedicle screw fixation for the treatment of thoracic TB can allow for TB lesion debridement, discectomy, and interbody fusion under direct visualization, and can effectively improve patient prognosis.
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Affiliation(s)
- Liang Deng
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
| | - Yuan-Wei Zhang
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
- Medical Department of Graduate School, Nanchang University, Nanchang,
Jiangxi, China
| | - Liang-Yu Xiong
- Department of Orthopedics, Zhangshu Municipal People’s Hospital, Yichun,
Jiangxi, China
| | - Su-Li Zhang
- Department of Surgery, Wujin Hospital Affiliated to Jiangsu University,
Changzhou, Jiangsu, China
| | - Wen-Yan Ni
- Department of Surgery, Wujin Hospital Affiliated to Jiangsu University,
Changzhou, Jiangsu, China
| | - Qiang Xiao
- Department of Orthopedics, Jiangxi Provincial People’s Hospital Affiliated
to Nanchang University, Nanchang, Jiangxi, China
- Qiang Xiao, Jiangxi Provincial People’s Hospital
Affiliated to Nanchang University, No. 152 Aiguo Road, Nanchang, Jiangxi 330006, China.
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Nagata K, Ando T, Sasaki K, Urayama D. Skipping Pedicle Screw Insertion Into Infected Vertebra is a Risk Factor for Revision Surgery for Pyogenic Spondylitis in the Lower Thoracic and Lumbar Spine. Int J Spine Surg 2020; 14:989-995. [PMID: 33560259 DOI: 10.14444/7148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Surgical intervention for pyogenic spondylitis is indicated when conservative treatment fails and biomechanical instability persists. Whether to insert pedicle screws into all vertebrae, including the most erosive vertebrae, or whether to skip 1 vertebra in pedicle screw insertion remains controversial. METHODS A single-institution retrospective cohort study was conducted in consecutive patients with pyogenic spondylitis in the lower thoracic and lumbar spine (T9-S1) between January 2008 and December 2016. The patients were treated with interbody fusion plus posterior stabilization using pedicle screws and were divided into 2 groups as follows: (1) patients in whom 1 vertebra, usually the most erosive, was skipped in pedicle screw insertion (Group Skipping) and (2) pedicle screw insertion into all vertebrae (Group All). Patients' operation data were evaluated, and clinical outcomes were compared between the 2 groups. There were no significant differences between the 2 groups in terms of age, sex, past histories, blood loss, operation time, the presence of abscesses, or operative approach. RESULTS The length of fixation was greater by 1 vertebral level in the Group Skipping than in the Group All, and the rate of revision surgery for pseudarthrosis was higher in the Group Skipping than in the Group All (P = .02). There was no statistically significant difference between the 2 groups in terms of the mean segmental lordotic angle or Barthel Index. CONCLUSIONS Skipping pedicle screw insertion for pyogenic spondylitis in posterior fixation led to an increased number of fixed vertebrae and may be a risk factor for revision surgery for pseudarthrosis. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The insertion of short pedicle screws at the infected vertebra can prevent early treatment failure and increase the biomechanical stability of construct.
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Affiliation(s)
- Kosei Nagata
- Department of Orthopaedic Surgery and Spinal Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Takeshi Ando
- Department of Orthopedic Surgery, Hitachi General Hospital, Ibaraki, Japan
| | - Katsuyuki Sasaki
- Department of Orthopedic Surgery, Hitachi General Hospital, Ibaraki, Japan
| | - Daiki Urayama
- Department of Orthopedic Surgery, Hitachi General Hospital, Ibaraki, Japan
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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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Nagata K, Ando T, Nakamoto H, Kato S, Sasaki K, Oshima Y. Adaptation and limitation of anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. J Orthop Sci 2019; 24:219-223. [PMID: 30318425 DOI: 10.1016/j.jos.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 08/12/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Surgical strategy for pyogenic spondylitis is controversial when vertebral body erosion is severe. Radical debridement and anterior column reconstruction is indicated for the purpose of early ambulatory to prevent secondary complication for long bed rest. However, such aggressive debridement and risk of perioperative complications are trade-off. The purpose of this study was to evaluate the risk factor of poor prognosis after anterior column debridement and reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine. METHODS We performed a retrospective review of 40 patients diagnosed with pyogenic spondylitis in lower thoracic and lumbar spine who were introduced to our institution due to losing ambulatory ability and underwent anterior column debridement and reconstruction between January 2008 and May 2016. After the patient population was split into a regaining ambulatory group (Group A; n = 23) and a poor prognosis group (Group P; n = 17), we used Fisher exact tests and t-tests as appropriate for univariate analyses to compare patient characteristics and outcomes between the 2 groups. RESULTS Univariate analysis showed that the significant variables were massive bleeding (>2000 ml) (P < 0.01), Charlson Comorbidity Index ≥3 (P = 0.01), and two-stage surgery needed (P = 0.04). Logistic regression analysis showed that the factors associated with poor prognosis were massive bleeding (Odds Ratio 11.9; 95% confidence interval 1.8 to 119.7; P = 0.04). CONCLUSIONS Massive bleeding was associated with poor prognosis after debridement followed by anterior column reconstruction for pyogenic spondylitis in lower thoracic and lumbar spine.
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Affiliation(s)
- Kosei Nagata
- The University of Tokyo Hospital, Japan; Hitachi General Hospital, Japan.
| | | | | | - So Kato
- The University of Tokyo Hospital, Japan
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He L, Xie P, Shu T, Liu Z, Feng F, Chen Z, Chen R, Zhang L, Rong L. Clinical and Radiographic Results of a Minimally Invasive Lateral Transpsoas Approach for Treatment of Septic Spondylodiscitis of the Thoracolumbar and Lumbar Spine. World Neurosurg 2018; 116:e48-e56. [PMID: 29626684 DOI: 10.1016/j.wneu.2018.03.193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND The minimally invasive lateral transpsoas approach allows retroperitoneal access for discectomy and graft placement. However, the procedure has rarely been used for the treatment of septic spondylodiscitis. The purposes of this study were to evaluate the clinical and radiographic outcomes from this minimally invasive procedure for septic spondylodiscitis. METHODS Thirty-one consecutive patients (17 males and 14 females) were included in this study from July 2013 to January 2016. Clinical outcomes were assessed by Oswestry Disability Index, visual analog scale, modified Macnab criteria, and inflammatory parameters. Radiographic results were analyzed by studying the changes in diseased disc height, lordosis, and fusion status. RESULTS The Oswestry Disability Index and visual analog scale score improved by 58% and 69% at the last follow-up. The modified Macnab criteria were found to be excellent in 21 patients (68%) and good in 10 (32%). Inflammatory parameters normalized over the average 24 months follow-up. There were no major complications that might have influenced the outcomes in this cohort. A complete fusion after 12 months was achieved in 87% of patients. A mean 7.5 mm restoration in disc height and 6.4° restoration in lumbar lordosis were observed in all patients, whereas an average 4.5 mm loss in restored height resulting from graft subsidence was observed in 24 patients during the follow-up. However, graft subsidence did not influence clinical outcomes significantly. CONCLUSIONS A minimally invasive lateral transpsoas approach in combination with instrumentation provides a novel treatment for patients with septic spondylodiscitis without severe kyphosis and neurologic impairment.
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Affiliation(s)
- Lei He
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Peigen Xie
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Tao Shu
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhongyu Liu
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Feng Feng
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zihao Chen
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruiqiang Chen
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liangming Zhang
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Limin Rong
- Department of Spine Surgery, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Chang J, Kim JS, Jo H. Ventral Dural Injury After Oblique Lumbar Interbody Fusion. World Neurosurg 2017; 98:881.e1-881.e4. [DOI: 10.1016/j.wneu.2016.11.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 11/04/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022]
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Posterior Only Approach for Lumbar Pyogenic Spondylitis With Short Instrumentation and Prolonged Suction Drainage. Spine (Phila Pa 1976) 2016; 41:E1022-E1029. [PMID: 26977850 DOI: 10.1097/brs.0000000000001566] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A single-institution, single-surgeon retrospective review. OBJECTIVE To assess the efficacy of posterior only approach with short instrumentation and prolonged suction drainage in managing lumbar pyogenic spondylitis. SUMMARY OF BACKGROUND DATA Several methods of posterior surgical treatment for pyogenic spondylitis have been reported, there have been few reports regarding the efficacy of posterior only approach with short instrumentation including even inflamed segment. METHODS Thirty-three patients with lumbar pyogenic spondylitis who underwent posterior decompression and lumbar interbody fusion with short instrumentation including the inflamed segment and catheter drainage were enrolled. Clinically infection control (erythrocyte sedimentation rate and C-reactive protein normalization time) and onset of ambulation were reviewed. Moreover, achievement of fusion and changes of sagittal alignment were investigated radiologically. RESULTS In all 33 cases, infection was controlled successfully without any recurrence. There was no breakage of implant. Postoperative interval to normalization of erythrocyte sedimentation rate was average 69.4 days and C-reactive protein was 25.4 days, respectively. Ambulation was started at average 5.8 postoperative days. Successful interbody fusion was confirmed radiologically in all the cases at a mean of 5.4 months. Sagittal angle of fixed segment was average 6.9 degrees of lordosis before operation, which became more lordotic to 11.5 degrees just after operation, but decreased to 4.7 degrees of lordosis at the final follow up. Actually final sagittal alignment was almost same as preoperative status (P = 0.24). CONCLUSION By achieving favorable clinical and radiological results, short instrumentation and prolonged suction drainage with posterior only approach seemed to be an effective method in managing lumbar pyogenic spondylitis. LEVEL OF EVIDENCE 3.
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