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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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Gao W, Zeng Y, Chen W. Multiple subcutaneous tuberculous abscesses in a dermatomyositis patient without pulmonary tuberculosis: a case report and literature review. BMC Infect Dis 2020; 20:409. [PMID: 32532200 PMCID: PMC7291664 DOI: 10.1186/s12879-020-05137-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/04/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Even though remarkable progress for diagnostics of pulmonary TB has been made, it is still a challenge to establish a definitive diagnosis for extrapulmonary TB (EPTB) in clinical practice. Among all the presentations of EPTB, cold abscesses are unusual and deceptive, which are often reported in the chest wall and spine. Subcutaneous abscess in the connective tissue of limbs is extremely rare. CASE PRESENTATION A 48-year-old man with dermatomyositis was hospitalized because of multiple subcutaneous tuberculous abscesses in his limbs, but without pulmonary tuberculosis. Particularly, one insidious abscess appeared during anti-TB treatment due to "paradoxical reaction". After routine anti-TB therapy, local puncture drainage and surgical resection, the patient was cured and discharged. CONCLUSIONS Tuberculous infection should be kept in mind for the subcutaneous abscess of immunocompromised patients, even without previous TB history. Treatment strategy depends on the suppurating progress of abscess lesions. Meanwhile, complication of newly-developed insidious abscess during treatment should be vigilant.
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Affiliation(s)
- Weiwei Gao
- Department of Tuberculosis, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
| | - Yi Zeng
- Department of Tuberculosis, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
| | - Wei Chen
- Clinical Research Center, the second hospital of Nanjing, Nanjing University of Chinese Medicine, 1-1 Zhongfu Road, Gulou district, Nanjing, 210003 Jiangsu province China
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Zhang Z, Hao Y, Wang X, Zheng Z, Zhao X, Wang C, Zhang X, Zhang X. Minimally invasive surgery for paravertebral or psoas abscess with spinal tuberculosis - a long-term retrospective study of 106 cases. BMC Musculoskelet Disord 2020; 21:353. [PMID: 32505204 PMCID: PMC7276089 DOI: 10.1186/s12891-020-03344-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
Background Minimally invasive surgery (MIS) is a common treatment option for paravertebral or psoas abscesses (PAs) in patients with spinal tuberculosis (ST). However, its efficacy remains controversial. The aim of the study was to evaluate the efficacy of MIS for PA with ST combined with anti-tuberculous chemotherapy. Methods A total of 106 consecutive patients who underwent MIS for ST with PA from January 2002 to Oct 2012 were reviewed. The MIS involved computed tomography (CT)-guided percutaneous catheter drainage and percutaneous catheter infusion chemotherapy. Clinical outcomes were evaluated based on the changes observed on preoperative and postoperative physical examination, inflammatory marker testing, and magnetic resonance imaging (MRI). Results The mean follow-up period was 7.21 ± 3.15 years. All surgeries were successfully completed under CT-guidance without intraoperative complications and all patients experienced immediate relief of their symptoms, which included fever and back pain. The preoperatively elevated erythrocyte sedimentation rate and C-reactive protein values returned to normal at a mean period of 3 months postoperatively. Solid bony union was observed in 106 patients and no abscesses were found on MRI examination. Conclusion MIS carries advantages in terms of less invasiveness, precise drainage, and enhanced local drug concentration. While the technique has not been fully characterized and clinically prove, its use in addition to conservative chemotherapy and open debridement and instrumental fixation may be recommended for patients with ST and PA.
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Affiliation(s)
- Zhifa Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Yongyu Hao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xiangyu Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Zhirong Zheng
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xuelin Zhao
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Chunguo Wang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China
| | - Xifeng Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
| | - Xuesong Zhang
- Department of Orthopaedics, the PLA General Hospital, Beijing, 100000, China.
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Lai Z, Shi S, Fei J, Han G, Hu S. A comparative study to evaluate the feasibility of preoperative percutaneous catheter drainage for the treatment of lumbar spinal tuberculosis with psoas abscess. J Orthop Surg Res 2018; 13:290. [PMID: 30454001 PMCID: PMC6245803 DOI: 10.1186/s13018-018-0993-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 10/31/2018] [Indexed: 11/25/2022] Open
Abstract
Background Spinal tuberculosis is a frequent cause of psoas abscess (PA), and PA largely negates the efficacy of antituberculosis therapy. This study aimed to investigate the clinical outcome of preoperative percutaneous catheter drainage (PCD) in patients with lumbar spinal tuberculosis and PA. Methods Between January 2015 and January 2017, 72 patients with lumbar spinal tuberculosis with PA were assigned to group A (preoperative PCD) and group B (n = 36 per group). All patients received posterior pedicle screw fixation and anterior focal debridement and fusion. Data on intraoperative blood loss, the duration of the surgery, and the length of the anterior incision were recorded, as well as the postoperative anal exhaust time, visual analogue scale (VAS), Cobb angle, lumbar vertebra function, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and sinus tract formation. Results Sixty-eight patients were followed up for an average time of 13 months (range 6–21 months). Until the final follow-up, no mixed infections, recurrence of tuberculosis, pedicle screw loosening, or screw pullout had occurred. There were significant between-group differences in blood loss, surgery duration, anterior incisional length, postoperative anal exhaust time, and sinus tract formation. As compared with group B, the ESR and CRP levels of the patients in group A were markedly improved following 3 weeks of antituberculosis therapy and 1 week postsurgery. Conclusion Preoperative PCD helps to increase the efficacy of antituberculosis therapy prior to surgery, reduce surgical trauma, and avoid postoperative complications, making it a safe and feasible treatment option for lumbar spinal tuberculosis with PA.
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Affiliation(s)
- Zhen Lai
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Shiyuan Shi
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
| | - Jun Fei
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Guihe Han
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Shengping Hu
- Department of Orthopedics, Hospital of Integrated Traditional Chinese and Western medicine in Zhejiang Province, 208 Huancheng E.Rd, Hangzhou, 310003, Zhejiang Province, People's Republic of China
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