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Lu Z, Ding C, Wei L, Zhang H. One-stage anterior focus debridement, interbody bone graft, and anterior instrumentation and fusion in the treatment of short segment TB. Medicine (Baltimore) 2022; 101:e32210. [PMID: 36550874 PMCID: PMC9771206 DOI: 10.1097/md.0000000000032210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
To evaluate the clinical efficacy of 1-stage anterior focus debridement, interbody bone graft, and anterior instrumentation and fusion in the treatment of short segment thoracic tuberculosis with paraplegia or incomplete paralysis. A total of 16 adult patients with short segment thoracic spinal thoracic tuberculosis who underwent surgery were enrolled in this retrospective study. All patients received anterior focus debridement, interbody bone graft and anterior instrumentation and fusion. All patients were followed up for 24 to 48 months. Clinical manifestations, laboratory examinations, neurological symptoms, bone fusion and imaging results were analyzed. All patients successfully underwent operations. The symptoms of chest and back pain were alleviated and even disappeared during postoperative 1 to 6 months. There was no recurrence. All patients got bony spinal fusion within postoperative 4 to 8 months assessed by spinal X-ray film. The levels of erythrocyte sedimentation rate and C-reactive protein were significantly decreased from 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L to 15.9 ± 4.6mm/h and 4.7 ± 2.0mg/L at the final follow-up, respectively (P < .05). The thoracic kyphosis angle was also notably decreased from 15.0 ± 3.4° to 9.1 ± 1.9° after operation(P < .05). During the follow-up, the symptom of paraplegia or incomplete paralysis was significantly improved. Neurologic status in all patients was also improved to some extent. The combination of 1-stage anterior focus debridement, interbody bone graft and anterior instrumentation and fusion is an effective and feasible treatment method for short segmental thoracic tuberculosis with paraplegia or incomplete paralysis.
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Affiliation(s)
- Zenghui Lu
- Department of Orthopaedics, Xi’an Chest Hospital, Xi’an, Shanxi Province, China
| | - Chao Ding
- Department of Thoracic Surgery, Xi’an Chest Hospital, Xi’an, Shanxi Province, China
| | - Lin Wei
- Department of Thoracic Surgery, Xi’an Chest Hospital, Xi’an, Shanxi Province, China
| | - Huijun Zhang
- Department of Orthopaedics, Xi’an Chest Hospital, Xi’an, Shanxi Province, China
- * Correspondence: Huijun Zhang, Department of Orthopaedics, Xi’an Chest Hospital, East Section of Aerospace Avenue, Chang’an District, Xi’an, Shanxi Province 710010, China (e-mail: )
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Debnath UK, McConnell JR, Kumar S. Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit. Int J Spine Surg 2021; 15:600-611. [PMID: 33985996 DOI: 10.14444/8081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion. METHODS A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity. RESULTS The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P < .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively. CONCLUSIONS Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity. LEVEL OF EVIDENCE 2.
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The Versatile Approach: A Novel Single Incision Combined with Anterior and Posterior Approaches for Decompression and Instrumented Fusion to Treat Tuberculosis of the Thoracic Spine. Asian Spine J 2017; 11:294-304. [PMID: 28443175 PMCID: PMC5401845 DOI: 10.4184/asj.2017.11.2.294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 10/12/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective case series. PURPOSE To describe a novel single incision that combines anterior and posterior approaches for decompression and instrumented fusion to treat tuberculosis of the thoracic spine and study the neurological and radiological outcomes. OVERVIEW OF LITERATURE Tuberculosis of the spine remains a major health issue in many developing countries. The options for treating tuberculosis of the thoracic spine include the anterior, posterior, and combined approaches, each with its advantages and disadvantages. METHODS Totally, 143 patients with tuberculosis of the thoracic spine were surgically treated using the "Versatile approach". Posterior fixation was performed using sublaminar wires and a Hartshill rectangle in all patients. Anterior reconstruction was accomplished using bone graft harvested from autologous rib, iliac crest, or fibula. RESULTS The study included 45 males and 98 females, with a mean age of 33.18±18.65 years (range, 3-82 years) and a mean follow-up of 60.23±24.56 months (range, 18-156 months). Kyphosis improved from a mean value of 24.02 preoperatively to 10.25 postoperatively. A preoperative neurological deficit was observed in 131 patients, with 130 patients regaining ambulatory power. No patient had deterioration of neurological status following surgery. Fusion was achieved in all cases. The visual analogscale score improved from an average score of 7.02 preoperatively to 1.51 at final follow-up. Eight patients had superficial macerations, which healed spontaneously. One patient had buckling of the anterior graft, and one patient had implant breakage following road traffic accident. CONCLUSIONS The "Versatile approach" is an effective, single-stage, single-incision method that combines anterior and posterior approaches for the surgically treating tuberculosis of the thoracic spine. It offers the advantage of direct visualization for decompression and reconstruction of the anterior and posterior vertebral columns, thus providing an excellent, long-lasting clinical outcome.
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Li X, En H, Zhang Y, Gao S, Li G, Guo Y, Wang X, Wang H, Cai Y, Wang Z, Li Z, Li C, Zhao F. Digital Anatomical Measurement for Anterolateral Fixation of Middle and Lower Thoracic Vertebrae. Med Sci Monit 2016; 22:5021-5027. [PMID: 27997524 PMCID: PMC5193122 DOI: 10.12659/msm.899062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The key to its successful application is to determine the best entry point for the vertebral screw(s). This study aimed to provide a reference for clinical anterolateral fixation through digital measurement of computed tomography (CT) data to identify relevant anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Material/Methods We performed digital measurement of anatomical positions in the middle and lower thoracic vertebrae (T4–T12) of 30 adults. Abbreviations: Left height of vertebral body, LHV; Right height of vertebral body, RHV; Anterior height of vertebral body, AHV; Middle height of vertebral body, MHV; Posterior height of vertebral body, PHV; Superior sagittal diameter of vertebral body, SSDV; Superior transverse diameter of vertebral body, STDV; inferior sagittal diameter of vertebral body, ISDV; Inferior transverse diameter of vertebral body, ITDV; (1) Left (right) height of vertebral body, [L(R)HV]; Anterior (middle, posterior) height of vertebral body [A(M,P)HV]; Superior (inferior) sagittal diameter of vertebral body, [S(I)SDV]; Superior (inferior) transverse diameter of vertebral body, [S(I)TDV]. Results The transverse diameters of vertebral bodies were always larger than the sagittal diameter for 3~4 mm. The distance between 2 vertebrae (interval of 1 vertebra) range were (52–56) mm for T4–T7 and (44–48) mm for T8–T12, and the surgeons could collate these data to choose a suitable stick length. Conclusions Bone graft should prune into laterigrade cuboid, it can recover A-P and bilateral physiological functions load, and the height of the vertebral body increased from T4 to T12.
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Affiliation(s)
- Xiaohe Li
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - He En
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yunfeng Zhang
- Department of CT, The Second Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Shang Gao
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Guimin Li
- The First Clinical College of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yu Guo
- The First Clinical College of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Xin Wang
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Haiyan Wang
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Yongqiang Cai
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Zhiqiang Wang
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Zhijun Li
- Department of Anatomy, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Cunbao Li
- Department of Biochemistry, Basic Medical College, Inner Mongolia Medical University, Hohhot, Inner Mongolia, China (mainland)
| | - Feifei Zhao
- Department of Ear-Nose-Throat, Affiliated Hospital of Inner Mongolia Medical University, Huhhot, Inner Mongolia, China (mainland)
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Wang H, Yang X, shi Y, Zhou Y, Li C, Chen Y, Yu H, Wang Q, Liu J, Cheng J, Zhao Y, Han J, Xiang L. Early predictive factors for lower-extremity motor or sensory deficits and surgical results of patients with spinal tuberculosis: A retrospective study of 329 patients. Medicine (Baltimore) 2016; 95:e4523. [PMID: 27559953 PMCID: PMC5400320 DOI: 10.1097/md.0000000000004523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/07/2016] [Accepted: 07/15/2016] [Indexed: 11/30/2022] Open
Abstract
Many studies about the characteristics of spinal tuberculosis (STB) have been published, but none has investigated the predictive factors for lower-extremity motor or sensory deficits (LMSD) in patients with STB.The objective of this study was to find early predictive factors for LMSD and evaluate surgical results of patients with STB.From 2001 through 2010, 329 patients with STB were treated in our department and surgical treatment was performed in 274 patients. The factors assessed included age, sex, duration of symptoms, worsening of illness, clinical symptoms, clinical signs, imaging characteristics, kyphotic angle, Oswestry disability index (ODI), and visual analogue scale (VAS) scores.Of the 329 patients studied, 164 presented with LMSD (the LMSD group), of which 93 patients (28.3%) had motor deficits and 177 patients (53.8%) had sensory disturbance. The other 165 patients were included in the control group (the No LMSD group). Using univariate logistic regression analysis, we found that the sex (P = 0.042), age (P = 0.001), worsening of sickness (P = 0.013), location (P = 0.009), and spinal compression (P = 0.035) were the risk factors of LMSD. Furthermore, the multivariate logistic regression analysis indicated that age (OR = 1.761, 95% CI: 1.227-2.526, P = 0.002), worsening of sickness (yes vs no: OR = 1.910, 95% CI: 1.161-3.141, P = 0.011), location (T vs C: OR = 0.204, 95% CI: 0.063-0.662, P = 0.008), and spinal compression (yes vs no: OR = 1.672, 95% CI: 1.020-2.741, P = 0.042) were independent risk factors of LMSD. Surgical treatment was performed in 274 patients. The kyphotic angle improved from 25.8 ± 9.1° preoperatively to 14.0 ± 7.6°, with a mean correction of 11.8 ± 4.0°, and a mean correction loss of 1.5 ± 1.8° at final visit. There were significant differences between the preoperative and the final ODI and VAS scores in both groups (P < 0.001 and P < 0.001, respectively).Spinal tuberculosis with cervical or lumbar vertebra involvement among the elder patients with a history of worsening of illness and spinal compression tended to cause LMSD, such as motor deficits or sensory disturbance. We should implement an appropriate treatment regimen to prevent exacerbation of STB such as operation, which can achieve thoroughness of debridement, adequate spinal stabilization, and better functional recovery.
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Affiliation(s)
- Hongwei Wang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics,
General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016
Liaoning, China (e-mail: ) or Lianbi Xiang, Department
of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA,
Shenyang, 110016 Liaoning, China (e-mail:
)
| | - Xiao Yang
- Department of Nursing, People's Liberation Army 463rd
Hospital, Shenyang, Liaoning
| | - Ying shi
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Yue Zhou
- Department of Orthopedics, Xinqiao Hospital, The Third
Military Medical University, Chongqing
| | - Changqing Li
- Department of Orthopedics, Xinqiao Hospital, The Third
Military Medical University, Chongqing
| | - Yu Chen
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Hailong Yu
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Qi Wang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Jun Liu
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
| | - Jiwei Cheng
- Department of Orthopedics, People's Liberation Army
113th Hospital, Ningbo, Zhejiang
| | - Yiwen Zhao
- State Key Laboratory of Robotics, Shenyang Institute of
Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Jianda Han
- State Key Laboratory of Robotics, Shenyang Institute of
Automation, Chinese Academy of Science, Shenyang, Liaoning, China
| | - Liangbi Xiang
- Department of Orthopedics, General Hospital of Shenyang
Military Area Command of Chinese PLA
- Correspondence: Hongwei Wang, Department of Orthopedics,
General Hospital of Shenyang Military Area Command of Chinese PLA, Shenyang, 110016
Liaoning, China (e-mail: ) or Lianbi Xiang, Department
of Orthopedics, General Hospital of Shenyang Military Area Command of Chinese PLA,
Shenyang, 110016 Liaoning, China (e-mail:
)
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Fry DE. Extra-Pulmonary Tuberculosis and Its Surgical Treatment. Surg Infect (Larchmt) 2016; 17:394-401. [DOI: 10.1089/sur.2016.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Donald E. Fry
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and the Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico
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Ren HL, Jiang JM, Wang JX, Qu DB, Chen JT. Is duration of preoperative anti-tuberculosis treatment a risk factor for postoperative relapse or non-healing of spinal tuberculosis? EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3875-3883. [PMID: 26951176 DOI: 10.1007/s00586-016-4496-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 02/22/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study evaluated the relationship between spinal TB postoperative recurrence or non-healing and duration of preoperative anti-TB treatment (ATT). METHODS From January 2004 to January 2013, patients who underwent surgery for spinal TB and met this study's inclusion criteria were retrospectively reviewed. Observed parameters were age, sex, initial ESR, preoperative ESR, degree of ESR change, initial CRP, preoperative CRP, degree of CRP change, duration of preoperative ATT, surgical approach, presence of internal fixation, location of spinal lesion, number of involved segments, duration of operation, and intraoperative blood loss. The data were analyzed by univariate and multivariate analyses for spinal TB recurrence or non-healing to determine related risk factors. RESULTS A total of 223 patients met the inclusion criteria. There were 84 female and 139 male patients with a mean age of 42.2 years (range 2-85 years). The follow-up period was 18-72 months (average 28.7 months). Among 223 patients observed, 23 patients had postoperative relapse or non-healing (10.3 %) during the follow-up period. Statistical analysis indicated that the location of a spinal lesion was significantly associated with postoperative relapse or non-healing. Risk of postoperative relapse or non-healing in thoracolumbar TB was 2.524-fold (95 % CI 1.026-6.580) that of lumbosacral TB. CONCLUSIONS Duration of preoperative ATT may not be a risk factor for postoperative recurrence or non-healing of spinal TB. Junctional zones such as the lumbosacral and thoracolumbar junction have a higher recurrence rate than non junctional.
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Affiliation(s)
- Hai-Long Ren
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Jian-Ming Jiang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Ji-Xing Wang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.
| | - Dong-Bin Qu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
| | - Jian-Ting Chen
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China
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