One-stage posterior debridement and single-segment interbody fusion for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adults following minimum 5-year follow-up

Simultaneous Single-Position Oblique Lateral Interbody Fusion Combined With Unilateral Percutaneous Pedicle Screw Fixation for Single-Level Lumbar Tuberculosis: A 3-Year Retrospective Comparative Study

OBJECTIVE

To illustrate a simultaneous single-position oblique lateral interbody fusion (SPOLIF) combined with unilateral percutaneous pedicle screw fixation in treating single-level lumbar tuberculosis, compared with posterior-only approach in clinical and radiographic evaluations.

METHODS

Consecutive patients who had undergone surgeries for single-level lumbar tuberculosis from January 2018 to December 2020 were retrospectively reviewed. The patients included were divided into SP-OLIF and posterior-only groups according to surgical methods applied, with follow-up for at least 36 months. Outcomes included estimated blood loss, operative time, and complications for safety evaluation; visual analogue scale (VAS), Oswestry Disability Index (ODI) for efficacy evaluation; erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) for evaluating tuberculosis activity; x-ray and computed tomography scan were used for radiographic evaluation.

RESULTS

A total of 136 patients had been enrolled in the study (60 for SP-OLIF and 76 for Posterior-only). The median operative time, blood loss, and hospital stay in SP-OLIF group were significantly less, with a lower complication rate. Meanwhile, the SP-OLIF group showed substantially lower VAS in 1 and 7 days and decreased ODI in the first month postoperatively, without significant difference afterward. Similarly, the median CRP and ESR in SP-OLIF group were significantly lower in 3 and 7 days postoperatively. All indicators had reduced to normal after 3 months. No recurrence had been reported throughout the whole follow-up.

CONCLUSION

SP-OLIF was an efficient minimally invasive protocol for single-level lumbar tuberculosis, facilitating earlier clinical improvement, with decreased blood loss, operative time and hospital stay compared with posterior-only approach.

Comparison of clinical efficacy and surgical safety among three bone graft modalities in spinal tuberculosis: a network meta-analysis

BACKGROUND

Autogenous granular bone graft (AG), autogenous massive bone graft (AM), and titanium mesh bone graft (TM) are the three commonly utilized bone implant methods for spinal tuberculosis. However, the gold standard is still controversial. Therefore, this study aimed to compare the clinical efficacy and surgical safety of three primary bone graft modalities.

METHODS

For systematic literature review, several databases, including PubMed, Embase, and Web of Science, were searched up to December 2022. Stata (version 14.0) was employed for data analysis.

RESULTS

Our network meta-analysis included 517 patients from 7 articles whose qualities are acceptable based on our quality assessment criteria. In direct comparison, AG was associated with a shorter operation time (MD = 73.51; CI 30.65-116.37) and a lesser blood loss (MD = 214.30; CI 7.17-421.44) than AM. TM had fewer loss of Cobb angle than AG (MD = 1.45; CI 0.13-2.76) and AM (MD = 1.21; CI 0.42-1.99). Compared with AG, TM (MD = 0.96; CI 0.06-1.87) was related to a shorter bone graft fusion time. In indirect comparison, for the clinical parameters, the rank of CRP (from best to worst) was as follows: TM (58%) > AM (27%) > AG (15%), the rank of ESR (from best to worst) was as follows: AG (61%) > AM (21%) > TM (18%), and the rank of VAS (from best to worst) was as follows: AG (65%) > TM (33%) > AM (2%). In the aspect of surgical data, what is noteworthy is that AG showed less blood loss [AG (93%) > TM (6%) > AM (1%)], operative time [AG (97%) > TM (3%) > AM (0)], and complications [AG (75%) > TM (21%) > AM (4%)] than AM and TM. As for imaging parameters, the rank of the loss of Cobb angle (from best to worst) was as follows: TM (99%) > AM (1%) > AG (0). Moreover, TM showed a shorter bone graft fusion time than AM and AG: TM (96%) > AM (3%) > AG (1%).

CONCLUSIONS

The results indicated that AG might be the optional treatment for spinal tuberculosis owing to the outcomes of surgical safety. Moreover, TM is another right choice which can significantly reduce the loss of Cobb angle and shorten bone graft fusion time with long-term follow-up.

Multitrack and multianchor point screw technique combined with the Wiltse approach for lesion debridement for lumbar tuberculosis

BACKGROUND

The incidence of lumbar tuberculosis is high worldwide, and effective treatment is a continuing problem.

AIM

To study the safety and efficacy of the multitrack and multianchor point screw technique combined with the contralateral Wiltse approach for lesion debridement to treat lumbar tuberculosis.

METHODS

The C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analogue scale (VAS) score, oswestry disability index (ODI) and American Spinal Injury Association (ASIA) grade were recorded and analysed pre- and postoperatively.

RESULTS

The CRP level and ESR returned to normal, and the VAS score and ODI were decreased at 3 mo postoperatively, with significant differences compared with the preoperative values (P < 0.01). Neurological dysfunction was relieved, and the ASIA grade increased, with no adverse events.

CONCLUSION

The multitrack, multianchor point screw fixation technique combined with the contralateral Wiltse approach for debridement is an effective and safe method for the treatment of lumbar tuberculosis.

Posterior transforaminal debridement and interbody fusion with instrumentation for multi-segment thoracic spinal tuberculosis: a midterm follow-up study

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.

Global Spinal Realignment After Osteotomized Debridement in Active Lumbar Spinal Tuberculosis: Correlation with Patient-Reported Outcomes

OBJECTIVE

Osteotomized debridement (OD) has been proved to be highly effective in treating active thoracolumbar tuberculosis (TB); however, no research has investigated how OD affects spinal alignment. The goal of this study was to explore the global alignment compensatory mechanism after lumbar OD, as well as the correlation between spinopelvic parameters and patient-reported outcomes (PROs).

METHODS

Sixty-two patients with active lumbar spinal TB who underwent OD surgery were included. Spinopelvic parameters (C2-7 Cobb angle [C2-7 CA], sagittal vertical axis [SVA], proximal thoracic kyphosis, thoracic kyphosis, lumbar lordosis [LL], sacral slope [SS], pelvic tilt [PT], pelvic incidence [PI], spinosacral angle, and PI minus LL [PI-LL]) and PROs (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS] score) were reviewed. The correlation between spinopelvic realignment and improved PROs was evaluated.

RESULTS

Compared with preoperative measurements, C2-7 CA, proximal thoracic kyphosis, thoracic kyphosis, LL, SS, and spinosacral angle significantly increased after OD, whereas SVA, PT, and PI-LL significantly decreased. ODI and VAS score significantly improved postoperatively. The improvement of VAS was observed to be correlated with variations of C2-7 CA, SVA, LL, and PI-LL. The improvement of ODI was found to be correlated with variations of SVA, LL, and PI-LL. The multiple stepwise regression analysis showed that LL was an independent predictor for ODI and VAS score.

CONCLUSIONS

The whole spine and pelvis are involved in realignment after lumbar spinal OD, which is closely related to PROs. More attention should be drawn to restoring an appropriate LL in lumbar TB surgery.

A comparison of three bone graft struts for interbody fusion using a posterior approach for lower lumbar spinal tuberculosis in adults: a midterm follow-up study

Background

This retrospective observational study was conducted to compare midterm outcomes of three bone graft struts for interbody fusion using a posterior approach in adults with lower lumbar spinal tuberculosis.

Methods

A total of 126 lower lumbar spinal tuberculosis patients were treated by one-stage posterior debridement, interbody fusion, and instrumentation. Forty-one patients (group A) were treated with autogenous bone graft for interbody fusion, 45 patients (group B) were treated with allogeneic bone grafting, and the remaining 40 (group C) patients were treated with titanium mesh cage. In addition, clinical and radiographic data were gathered and analyzed.

Results

At the final follow-up, all patients were completely cured. The operation period and intraoperative blood loss for groups B and C were significantly less than in group A (P = 0.000). Post-operation, neurological performance and quality of life were remarkably improved at the final follow-up. The preoperative lordosis angles of three groups were significantly improved, as evidenced by the values immediately after the operation or those at the final follow-up. The correction loss of the group C was lower than those of groups A and B (P = 0.000). All the patients obtained bone graft fusion, the fusion period of group B was longer than that of the other two groups (P = 0.000). No significant differences among the three groups in adjacent segment degeneration rates were found at the last visit (P = 0.922).

Conclusions

This midterm follow-up study established that one-stage posterior debridement, interbody fusion, and instrumentation, combined with medical therapy, can effectively treat lower lumbar spinal tuberculosis. In addition, the intervertebral titanium mesh cage bone graft can provide better outcomes with regard to maintaining lordosis and preventing collapse.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05539-8.

Efficacy of anterior debridement and bone grafting with fusion using internal fixation combined with anti-tuberculosis chemotherapy in the treatment of subaxial cervical tuberculosis

Background

To evaluate the efficacy of anterior debridement and bone grafting with fusion using internal fixation (BFIF) combined with anti-tuberculosis chemotherapy in the treatment of subaxial cervical spine tuberculosis (SCS-TB).

Methods

Clinical and radiographic data of patients with SCS-TB treated by anterior debridement and BFIF at our hospital from January 2010 to December 2017 were analyzed retrospectively. The SCS sagittal parameters at the preoperative, postoperative, and final follow-up were documented and compared, including the Occiput-C2 angle, C2–C7 Cobb angle, local Cobb angle, spinal canal angle (SCA), C2–C7 sagittal vertical axis (C2–C7 SVA), the center of gravity of the head-C7 sagittal vertical axis (CGH-C7 SVA), T1 slope (T1S), neck tilt (NT), and thoracic inlet angle (TIA). The ASIA grade, NDI index, JOA score, and VAS score were utilized to assess the postoperative function recovery, and the complications were recorded.

Results

A total of 23 patients were included in the study with a mean age of 46.74 ± 15.43 years, including 8 males and 15 females. All patients with SCS-TB were treated with anterior debridement and BFIF, with a mean postoperative follow-up time of 37.17 ± 12.26 months. The poisoning symptoms of TB were relieved in all patients, and ESR (42.09 ± 9.53 vs 8.04 ± 5.41, P < 0.05) and CRP (30.37 ± 16.02 vs 7.4 ± 2.68, P < 0.05) were decreased at the 3 postoperative months in the comparison of the preoperative. The C0–C2 Cobb angle, C2–C7 Cobb angle, local Cobb angle, SCA, TIS, C2–C7 SVA, and CGH-C7 SVA were corrected remarkably after surgery (P < 0.05). Further, there was a significant improvement in the JOA, VAS, and NDI with the comparison of the preoperative (P < 0.05).

Conclusions

Anterior debridement and BFIF combined with anti-TB chemotherapy was a practical tool for the treatment of SCS-TB with the help of SCS sagittal parameters, which can remove the lesion completely, decompress the spinal cord compression, and correct the kyphotic deformity to restore the spine sagittal balance.

Intervention of WeChat Group Guidance in Rapid Rehabilitation after Gynecological Laparoscopic Surgery

Gynecological laparoscopic surgery is the current routine treatment. Although the injury is relatively small, it is still a traumatic operation and also increases the recovery speed of patients. This paper mainly explores the intervention effect of rapid rehabilitation after gynecological laparoscopic surgery by means of WeChat group guidance based on the information adoption model and UTAUT model. Gynecological patients who underwent laparoscopic surgery and met the inclusion and exclusion conditions in a provincial maternal and child health hospital were selected as the research objects. The WeChat intervention group was compared with the nonintervention group, and the oral description score (VRS), comfort score (BCS), and 40-item recovery quality rating scale (QoR-40) were used as the scoring criteria. The results showed that the postoperative VRS and BCS scores in the WeChat intervention group were significantly lower than those in the nonintervention group. The total score of QoR-40 in both groups decreased compared with that before operation, reached the lowest on the first day after operation, and began to rise from the second day. This result is consistent with the patient's postoperative recovery process. After operation, the total score of the WeChat intervention group on days 1 and 2 was higher than that of the non-WeChat intervention group. By comparing the results of the patient's postoperative oral description score (VRS), comfort score (BCS), 40-item recovery quality score scale (QoR-40), etc., it can be shown that the overall recovery quality of the WeChat intervention group was better during these two days. In each section, the oral description score (VRS) and the 40-item recovery quality score scale (QoR-40) indicated that the pain sensation and emotional state scores of patients in the WeChat intervention group were higher than those in the nonintervention group, while the comfort score (BCS) was lower, indicating better comfort in the WeChat intervention group.

Medium-Term Follow-Up Outcomes of One-Stage Posterior Lumbosacral or Lumbopelvic Fixation in the Management of Lumbosacral Junction Tuberculosis in Adults

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.

The Comparative Influence of 2 and 4 Weeks Preoperative Antituberculosis Treatment on Spinal Tuberculosis Surgery: A Multicenter, Prospective, Randomized Clinical Trial

INTRODUCTION

A trade-off between successful surgery and minimizing the operation delay for patients with spinal tuberculosis (TB) is a major consideration to determine the duration of preoperational anti-TB treatment (AAT). In this study, 2 and 4 weeks preoperative AAT durations were compared for their influence on the operation outcomes.

METHOD

A multicenter, prospective, randomized trial was conducted in four hospitals in China. New patients with spinal TB were recruited and randomly allocated to two groups (2 or 4 weeks' preoperative treatment) and administered the standardized first-line anti-TB drugs. The symptom changing and indicators reflecting recovery and side effects of the treatment were monitored. Patient was followed up for another 18 months after completion of treatment.

RESULTS

In total, 150 eligible patients were enrolled between June 2014 and December 2016, and 13 patients were excluded after the enrollment. The remaining 137 participants were randomly allocated to the 2-week group (n = 68) or the 4-week group (n = 69). These two groups acquired similar surgical outcomes, considering wound healing rate within 3 months after the operation (94.20%, 65/69 vs 89.71%, 61/68; P = 0.333) and bony fusion rate within 6 months (98.46%, 64/65 vs 95.45%, 63/66; P = 0.317). However, the culture positive rate of pus collected during operation in the 4-week group (41.94%) was significantly lower than that of the 2-week group (60.94%, P = 0.033). No reoccurrence of disease was observed in either group during the 18-month follow-up period.

CONCLUSION

Patients with spinal TB administered 2 or 4 weeks of preoperative anti-TB treatment acquired similar surgical outcomes. However, patients who underwent the operation sooner suffered 2 weeks less agony from the disease.

Selection of the fusion and fixation range in the intervertebral surgery to correct thoracolumbar and lumbar tuberculosis: a retrospective clinical study

Background

To compare the diseased verses the non-diseased intervertebral surgery used in the treatment of thoracolumbar and lumbar spinal tuberculosis and to explore the best choice of fusion of fixation range.

Methods

Two hundred twenty-one patients with thoracolumbar and lumbar tuberculosis were categorized into two groups. One hundred eighteen patients underwent the diseased intervertebral surgery (lesion vertebral pedicle fixation, Group A) and 103 patients underwent the non-diseased intervertebral surgery (1 or 2 vertebral fixation above and below the affected vertebra, group B). Spinal tuberculosis diagnosis was confirmed in both groups of patients before lesion removal, bone graft fusion, and internal fixation. Clinical data and efficacy of the two surgical methods were then evaluated.

Results

The mean follow-up duration for both procedures was 65 months (50–68 months range). There were no significant differences in laboratory examinations, VAS scores, and the Cobb angle correction rate and the angle loss. However, significant differences existed in the operation time, blood loss, serosanguineous drainage volume, and blood transfusion requirement between the two groups. The diseased intervertebral surgery group performed significantly better than the non-diseased intervertebral surgery group in all of these areas. In both cases, the bone graft fused completely with the normal bone by the last follow-up, occuring at 50–86 months post surgery.

Conclusion

The diseased intervertebral surgery is a safe and feasible option for the treatment of thoracolumbar and lumbar tuberculosis. It effectively restores the physiological curvature of the spine and reduces the degeneration of adjacent vertebral bodies in the spinal column.