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Liu J, Gong X, Wang K, Li X, Zhang X, Sun J, Zhu Y, Ai Y, Ren J, Xiu J, Ji W. A comparison of the biomechanical properties of three different lumbar internal fixation methods in the treatment of lumbosacral spinal tuberculosis: finite element analysis. Sci Rep 2023; 13:11354. [PMID: 37443369 PMCID: PMC10344955 DOI: 10.1038/s41598-023-32624-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 03/30/2023] [Indexed: 07/15/2023] Open
Abstract
There are various internal fixation methods in treating lumbosacral spinal tuberculosis. The study compared the stability and stress distribution in surrounding tissues/implants, such as discs, endplates and screw-rod internal fixation system, etc. when applying three different lumbar internal fixation methods to treat lumbosacral spinal tuberculosis. A finite element model was constructed and validated. The spinal stability was restored using three methods: a titanium cage with lateral double screw-rod fixation (group 1), autologous bone with posterior double screw-rod fixation (group 2), and a titanium cage with posterior double screw-rod fixation (group 3). For comparison, group 4 represented the intact L3-S1 spine. Finally, a load was applied, and the ranges of motion and Von Mises stresses in the cortical endplates, screw-rod internal fixation system and cortical bone around the screws in the different groups were recorded and analyzed. All six ranges of motion (flexion, extension, left/right lateral bending, left/right rotation) of the surgical segment were substantially lower in groups 1 (0.53° ~ 1.41°), 2 (0.68° ~ 1.54°) and 3 (0.55° ~ 0.64°) than in group 4 (4.48° ~ 10.12°). The maximum stress in the screw-rod internal fixation system was clearly higher in group 2 than in groups 1 and 3 under flexion, left/right lateral bending, and left/right rotation. However, in extension, group 1 had the highest maximum stress in the screw-rod internal fixation system. Group 2 had the lowest peak stresses in the cortical endplates in all directions. The peak stresses in the cortical bone around the screws were higher in group 1 and group 2 than in group 3 in all directions. Thus, titanium cage with posterior double screw-rod fixation has more advantages in immediate reconstruction of lumbosacral spinal stability and prevention of screw loosening.
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Affiliation(s)
- Jiantao Liu
- Department of Orthopedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China.
| | - Xi Gong
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Kao Wang
- Medical School of Yan'an University, Yan'an, 716000, China
| | - Xingyuan Li
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Xiwei Zhang
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jiajun Sun
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yihan Zhu
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Yixiang Ai
- Xi'an Jiaotong University, Xi'an, 710049, China
| | - Jing Ren
- Department of Orthopedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Jintao Xiu
- Department of Orthopedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Wenchen Ji
- Department of Orthopedics, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
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Primadhi RA, Prasetia R, Rahim AH, Mulyadi D. Short-term outcomes of one-stage debridement and fusion for ankle joint tuberculosis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:587-592. [PMID: 36028592 DOI: 10.1007/s00590-022-03376-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 08/22/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Tuberculosis remains a worldwide health problem, as well as its complications including arthritis in various joints. End-stage arthritis in weight-bearing joint would require surgery either arthroplasty or arthrodesis, in order to achieve painless and stable gait. In general, staged surgery consisted of debridement and subsequent definitive procedure is accepted. However, multiple surgery would be disadvantageous in terms of clinical and economic burdens. This study reported the short-term result of one-stage debridement and fusion for ankle joint tuberculosis. METHODS Retrospective evaluation of twenty-six patients with history of one-stage debridement and ankle fusion was conducted. Basic anthropometric measurement, local status, and surgical technique were recorded. Functional score using Foot and Ankle Ability Measures (FAAM) activities of daily living (ADL) was assessed pre-operatively and at two and half year post-surgery follow-up visit along with radiological fusion rate. Paired t test was used to analyse the improvement of the clinical scores. RESULTS There was improvement in FAAM score from 43.38 ± 9.51 to 62.19 ± 6.63% (p < 0.001). All sinuses had been subsided, albeit at various time spans. Modified radiographic union score for tibia (RUST) revealed various fusion rate results, ranged from 5 to 11. CONCLUSION One-stage debridement and fusion is proven efficacious for end-stage joint tuberculosis, with less surgery occasion compared with staged surgery. However, patient selection is important since any comorbidities or secondary infection may complicate the fusion.
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Affiliation(s)
- Raden Andri Primadhi
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia.
| | - Renaldi Prasetia
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia
| | - Agus Hadian Rahim
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia
| | - Dicky Mulyadi
- Department of Orthopaedics and Traumatology, Universitas Padjadjaran Medical School/Hasan Sadikin Hospital, Jalan Pasteur 38, Bandung, 40161, Indonesia
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Zhang Z, Hu BW, Wang LN, Li T, Yang HL, Liu LM, Song YM, Zhou ZJ. Comparison of Long-Term Clinical and Radiographical Outcomes between the Anterior and Combined Anterior and Posterior Approaches for Treating Lumbosacral Tuberculosis. Orthop Surg 2023; 15:973-982. [PMID: 36750359 PMCID: PMC10102319 DOI: 10.1111/os.13682] [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] [Received: 10/21/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Both anterior and combined anterior and posterior approaches have been used to treat lumbosacral tuberculosis. However, long-term follow-up studies of each approach have not been conducted. We aimed to compare the long-term clinical and radiographical outcomes between the two approaches. METHODS In this retrospective cohort study, we included 49 patients with a minimum 6-year follow-up between January 2008 and March 2012. Twenty-four patients underwent the anterior approach (anterior group), and 25 underwent the combined anterior and posterior approach (anterior-posterior group). Student's t test, Mann-Whitney U test, and Pearson's chi-square test were used to compare the two groups regarding clinical data, such as visual analogue scale scores, Oswestry disability index scores and neurological status, and radiographical data, such as lumbosacral angle, lumbar lordosis, and L5-S1 height. Furthermore, operative time, length of stay, and intraoperative and postoperative blood loss (IBL, PBL) were recorded. RESULTS Both groups had satisfactory clinical and radiographical outcomes until the final follow-up. All patients achieved bony fusion, and no group differences were found in any of the clinical indices. Both groups corrected and maintained the lumbosacral angle, lumbar lordosis, and L5-S1 height. However, the operative time, length of stay, maximum Hb drop, IBL, and PBL of the anterior group (140.63 ± 24.73 min, 12.58 ± 2.45 days, 28.33 ± 9.70 g/L, 257.08 ± 110.47 ml, and 430.60 ± 158.27 ml, respectively) were significantly lower than those of the anterior-posterior group (423.60 ± 82.81 min, P < 0.001; 21.32 ± 3.40 days, P < 0.001; 38.48 ± 8.03 g/L, P < 0.001; 571.60 ± 111.04 ml, P < 0.001; and 907.01 ± 231.99 ml, P < 0.001). CONCLUSION This retrospective study demonstrated long-term efficacy of the anterior approach with a single screw fixation, which was as effective as that of the combined anterior and posterior approach, with the advantage of less trauma.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bo-Wen Hu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Lin-Nan Wang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hui-Liang Yang
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Li-Min Liu
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yue-Ming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Zhong-Jie Zhou
- Department of Orthopaedics, Orthopaedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Wang X, Long Y, Li Y, Guo Y, Mansuerjiang M, Tian Z, Younusi A, Cao L, Wang C. Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis. Front Surg 2023; 9:1024510. [PMID: 36684311 PMCID: PMC9852336 DOI: 10.3389/fsurg.2022.1024510] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/10/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aims to investigate the effectiveness and feasibility of biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation for lumbar brucellosis spondylitis (LBS). Methods The data of 13 patients with LBS were retrospectively analyzed, who underwent biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation from May 2020 to June 2022. The patients' clinical data, the duration of operation, the estimated blood loss (including postoperative drainage), and complications were recorded. Clinical outcomes include serum agglutination test (SAT) measures Brucella antibody titer, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), the visual analog scale (VAS) scores of low back and leg, Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), American Spinal Injury Association neurological classification, and lordotic angle were analyzed. All patients were assessed using the modified Macnab criteria at the final follow-up. The intervertebral bone graft fusion was assessed using the Bridwell grading criteria. Results The mean operation duration was 177.31 ± 19.54 min, and the estimated blood loss was 176.15 ± 43.79 ml (including postoperative drainage was 41.15 ± 10.44 ml). The mean follow-up period was 13.92 ± 1.5 months. SAT showed that the antibody titers of 13 patients were normal 3 months after the operation and at the final follow-up. ESR and CRP levels returned to normal by the end of the 3-month follow-up. VAS scores of low back and leg, JOA score, and ODI significantly improved after the operation throughout the follow-up period (P < 0.05). Based on the modified Macnab criteria, 92.3% showed excellent to good outcomes. One patient had only a percutaneous screw internal fixation on the decompression side due to severe osteoporosis. One case suffered a superficial incision infection postoperatively that healed with dressing change and effective antibiotic treatment. Bony fusion was obtained in all patients at the last follow-up, including 12 cases with grade I and 1 case with grade II, with a fusion rate of 92.31%. Conclusion Biportal endoscopic decompression, debridement, and interbody fusion, combined with percutaneous screw fixation is an effective, safe, and viable surgical procedure for the treatment of LBS.
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Affiliation(s)
- Xiangbin Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Yubin Long
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yong Li
- Department of Spinal Surgery, Hunan Shaoyang Central Hospital, Shaoyang, China
| | - Yun Guo
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Maiwulan Mansuerjiang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Zheng Tian
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Aikebaier Younusi
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Li Cao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
| | - Chong Wang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,Correspondence: Chong Wang Li Cao
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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, Zhang Z, Wang X, Zhang Y, Wu Y. Medium-Term Follow-Up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults. Orthop Surg 2021; 13:2051-2060. [PMID: 34590777 PMCID: PMC8528990 DOI: 10.1111/os.13150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/23/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To evaluate the medium‐term outcomes of one‐stage posterior lumbosacral or lumbopelvic fixation treatment of lumbosacral junction tuberculosis in adults. Methods This retrospective study enrolled a total of 38 adult patients (24 males and 14 females) with an average age of 48.0 ± 13.0 years (range, 25–75 years) during the period from February 2008 to July 2015. All patients were treated by one‐stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage. After pedicle screw or iliac screw fixation, a hemi‐laminectomy or laminectomy was performed on the severely damaged side of the lesion segment. Intervertebral bone grafting and intertransverse bone grafting were performed after clearing the focus of tuberculosis. All cases were followed up for at least 5 years. Intraoperative blood loss, operative time, erythrocyte sedimentation rate (ESR), pain intensity was assessed by visual analog scale (VAS) score; neurological function was assessed by Japanese Orthopaedic Association (JOA) score; quality of life was assessed by Oswestry Disability Index (ODI); functional outcome, lumbosacral angle, and fusion time were gathered and analyzed. All data expressed as mean ± standard deviation. Results During the 66.2 ± 4.4 months (range, 60–78 months) follow‐up, all patients achieved clinical cure without severe complications. The intraoperative blood loss was 726.3 ± 151.9 mL (range, 400–1100 mL) and the operative time was 137.6 ± 22.5 min (range, 110–200 min). The ESR decreased to normal levels within (11.8 ± 2.6 mm/h) 3 months postoperatively. The VAS score significantly decreased from 6.8 ± 1.1 preoperatively to 0.8 ± 0.7 at the final follow‐up (P < 0.01). The mean JOA improved from preoperative 18.5 ± 2.9 to 26.9 ± 1.1 at the last visit (P < 0.01). The mean ODI was 44.3 ± 6.7 and significantly decreased to 9.3 ± 1.9 at the final observation (P < 0.01). Patient‐reported outcomes as measured by Kirkaldy‐Willis criteria were excellent in 21 cases, good in 16 cases, and fair in one case; there were no poor outcomes. Lumbosacral angle increased from the preoperative values of 21.7° ± 1.8° to the postoperative values of 26.4° ± 1.4° (P < 0.01), with an angle loss of 1.2° ± 0.7° at the last follow‐up. Bone fusion occurred on average 12.8 ± 1.9 months (range, 9–15 months) after surgery. No nonunion, pseudarthrosis, loosening or fracture of instruments occurred at the last follow‐up. Conclusion One‐stage posterior debridement, interbody fusion, lumbosacral or lumbopelvic fixation, and postural drainage according to the severity of sacral destruction is an effective and highly safe procedure to treat lumbosacral junction tuberculosis in adults.
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Affiliation(s)
- Zhenchao Xu
- Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, Changsha, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China
| | - Zhen Zhang
- Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, Changsha, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China
| | - Xiyang Wang
- Department of Spine Surgery and Orthopaedics, The Xiangya Hospital of Central South University, Changsha, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China
| | - Yilu Zhang
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China
| | - Yunqi Wu
- Hunan Engineering Laboratory of Advanced Artificial Osteo-Materials, Changsha, China
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Na P, Mingzhi Y, Yin X, Chen Y. Surgical management for lumbar brucella spondylitis: Posterior versus anterior approaches. Medicine (Baltimore) 2021; 100:e26076. [PMID: 34032738 PMCID: PMC8154373 DOI: 10.1097/md.0000000000026076] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 05/04/2021] [Indexed: 01/04/2023] Open
Abstract
There has been no ideal surgical approach for lumbar brucella spondylitis (LBS). This study aims to compare clinical efficacy and safety of posterior versus anterior approaches for the treatment of LBS.From April 2005 to January 2015, a total of 27 adult patients with lumbar brucella spondylitis were recruited in this study. The patients were divided into 2 groups according to surgical approaches. Thirteen cases in group A underwent 1-stage anterior debridement, fusion, and fixation, and 14 cases in group B underwent posterior debridement, bone graft, and fixation. The clinical and surgical outcomes were compared in terms of operative time, intraoperative blood loss, hospitalizations, bony fusion time, complications, visual analog scale score, recovery of neurological function, deformity correction.Lumbar brucella spondylitis was cured, and the grafted bones were fused within 11 months in all cases. It was obviously that the operative time and intraoperative blood loss of group A were more than those of group B (P = .045, P = .009, respectively). Kyphotic deformity was signifcantly corrected in both groups after surgery; however, the correction rate was higher in group B than in group A (P = .043). There were no significant differences between the two groups in hospitalizations, bony fusion time, and visual analog scale score in the last follow-up (P = .055, P = .364, P = .125, respectively).Our results suggested that both anterior and posterior approaches can effectively cure lumbar brucella spondylitis. Nevertheless, posterior approach gives better kyphotic deformity correction, less surgical invasiveness, and less complications.
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Affiliation(s)
- Peng Na
- Department of the Fifth internal medicine, Thoracic Hospital of Hunan province, Changsha, Hunan
| | - Yang Mingzhi
- The Spinal Surgery Department of The First Affiliated Hospital Of University Of South China
| | - Xinhua Yin
- Department of Spine Surgery, Hong Hui Hospital, Xi’an Jiaotong University College of Medicine, Xi’an, China
| | - Yong Chen
- The Spinal Surgery Department of The First Affiliated Hospital Of University Of South 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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Minimally invasive spinal surgery in spinal infections – A review. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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10
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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 J, Gao Y, Gao Z, Niu B, Lv D, Yang Y. Initial stability of one-stage anterior debridement and cage implantation combined with anterior-lateral fixation by a dual screw-rod construct in the treatment of lumbosacral tuberculosis: a cadaveric biomechanical study. BMC Musculoskelet Disord 2019; 20:206. [PMID: 31077171 PMCID: PMC6511140 DOI: 10.1186/s12891-019-2592-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/26/2019] [Indexed: 11/26/2022] Open
Abstract
Background Although various surgical methods are used to treat lumbosacral tuberculosis, no unified surgical approach exists. Thus, exploring an optimal operation method has substantial clinical importance. Evaluate the initial stability of a new surgical method, a one-stage anterior debridement and cage implantation combined with anterior-lateral fixation by a dual screw-rod construct, in the treatment of lumbosacral tuberculosis and provide biomechanical support for its further promotion in clinical applications. Methods Fifteen fresh human lumbosacral spine specimens without fractures, deformities or osteoporosis were randomly divided into intact (I), anterior fixation (AF) and posterior fixation (PF) groups. All AF and PF group specimens had subtotal resections of the L5 vertebra and adjacent discs, while the I group specimens were kept intact. Then, titanium cages were implanted in the surgical site and a dual screw-rod construct was fixed anterior-laterally in the AF group, while the PF group specimens were fixed posteriorly with only the dual screw-rod construct. Mechanical tests were conducted for initial stability evaluations. Results The load at the maximum displacement (5 mm) or rotation angle (5 °) was less for the I group specimens than for the AF and PF group specimens in all directions (P < 0.05). The load at the maximum displacement (5 mm) was greater for the AF group specimens than for the PF group specimens in flexion, lateral bending and axial compression (P < 0.05) and lower than in the PF group specimens in extension (P < 0.05). In torsion, there was no difference between the loads in the AF and PF groups at the maximum rotation angle (5 °) (P > 0.05). Conclusions: The proposed surgical approach can provide better immediate stability than anterior debridement with posterior dual screw-rod fixation in the treatment of lumbosacral tuberculosis in flexion, lateral bending and axial compression.
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Affiliation(s)
- Jiantao Liu
- Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Yanzheng Gao
- Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Zhengchao Gao
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Binbin Niu
- Department of Orthopedics, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Dongbo Lv
- Department of Spine and Spinal Cord Surgery, Henan Provincial People's Hospital, Zhengzhou, Henan Province, China
| | - Yin Yang
- Department of Orthopedics, Xi'an Central Hospital, Xi'an, Shaanxi Province, China.
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Zheng B, Hao D, Guo H, He B. Anterior versus posterior surgical approach for lumbosacral tuberculosis. J Int Med Res 2018; 46:2569-2577. [PMID: 29584540 PMCID: PMC6124266 DOI: 10.1177/0300060518764933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To compare two different approaches for the treatment of lumbosacral tuberculosis. Patients and Methods In total, 115 patients who were surgically treated in our department from July 2010 to July 2014 were included in this retrospective study. They were divided into the anterior and posterior approach groups. Intraoperative hemorrhage; the surgery time; the Cobb angle preoperatively, postoperatively, and at the follow-up visit (2 years postoperatively); visual analog scale (VAS) pain scores before and after surgery; and Oswestry Disability Index (ODI) scores before and after surgery were compared between the two groups. Results The Cobb angle and VAS and ODI scores were significantly improved in both groups after surgery. Significant differences were found in the operation time, intraoperative hemorrhage, Cobb angle correction, and loss of correction at the last follow-up. No significant differences were found in the VAS and ODI scores between the groups. Conclusions The posterior approach is superior to the anterior approach with respect to the surgery time, intraoperative hemorrhage, and Cobb angle postoperatively and at the last follow-up. When both approaches can be carried out for a patient with lumbosacral tuberculosis, the posterior approach should be favored over the anterior approach.
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Affiliation(s)
- Bolong Zheng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Hua Guo
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China
| | - Baorong He
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shanxi, China
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One-Stage Anterolateral Debridement, Bone Grafting, and Internal Fixation for Treating Lumbosacral Tuberculosis. Asian Spine J 2017; 11:305-313. [PMID: 28443176 PMCID: PMC5401846 DOI: 10.4184/asj.2017.11.2.305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 12/30/2022] Open
Abstract
Study Design Retrospective case series. Purpose To investigate the clinical efficacy and feasibility of one-stage anterolateral debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis. Overview of Literature There has been no consensus regarding the optimal means of treating lumbosacral tuberculosis. The one-stage anterolateral extraperitoneal approach for radical debridement, bone grafting, and internal fixation for treating lumbosacral tuberculosis is rare in literature. Methods Twenty-one patients with lumbosacral tuberculosis were retrospectively analyzed. All patients underwent the surgery of anterolateral debridement after regularly antituberculous drugs therapy. We evaluated the erythrocyte sedimentation rate, C-reactive protein, radiography, computed tomography, magnetic resonance imaging, visual analogue score, and Oswestry disability index before and after surgery. Results All patients completed a follow-up survey 9–48 months after surgery. All patients' wounds healed well without chronic infection or sinus formation, and all patients with low-back pain reported relief after surgery. All cases had no tuberculosis recurrence. Solid bony fusion was achieved within 6–12 months. At final follow-up, evaluated the erythrocyte sedimentation rate decreased from 38.1±12.5 to 11.3±7.1 mm/hr, C-reactive protein decreased from 6.2±4.2 to 1.6±1.3 mg/dL, the visual analog scale score decreased from 4.6±1.1 to 1.4±1.0, the Oswestry disability index score decreased from 50.2%±11.9% to 13.0%±6.6%, and the lumbosacral angle increased from 20.0°±4.8° to 29.0°±3.9° (p<0.05). Conclusions One-stage anterolateral debridement, bone grafting, and internal instrument fixation for treating lumbosacral tuberculosis is safe and effective.
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Surgical management of Pott’s spine induced kyphosis in older children or adults. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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