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Liu Y, Liu Q, Duan X, Wang W, Pu L, Luo B, He D. One-stage posterior transpedicular debridement, hemi-interbody and unilateral-posterior bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis: a retrospective study. Acta Neurochir (Wien) 2024; 166:65. [PMID: 38315247 DOI: 10.1007/s00701-024-05966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 01/06/2024] [Indexed: 02/07/2024]
Abstract
PURPOSE To investigate the clinical efficacy and feasibility of the surgical treatment of thoracic spinal tuberculosis using one-stage posterior instrumentation, transpedicular debridement, and hemi-interbody and unilateral posterior bone grafting. METHODS Fifty-six patients with thoracic spinal tuberculosis who underwent surgery performed by a single surgeon between September 2009 and August 2020 were enrolled in this study. Based on data from the erythrocyte sedimentation rate (ESR), Visual Analog Scale (VAS), and Cobb angle before surgery, after surgery, and at the most recent follow-up, clinical effectiveness was assessed using statistical analysis. The variables investigated included operating time, blood loss, complications, neurological function, and hemi-interbody fusion. RESULTS None of the patients experienced significant surgery-associated complications. At the last follow-up, 23 of the 25 patients (92%) with neurological impairment showed improvement. The thoracic kyphotic angle was significantly decreased from 24.1 ± 9.9° to 13.4 ± 8.6° after operation (P < 0.05), and the angle was 14.44 ± 8.8° at final follow-up (P < 0.05). The Visual Analog Scale significantly decreased from 6.7 ± 1.4 preoperatively to 2.3 ± 0.8 postoperatively (P < 0.05) and finally to 1.2 ± 0.7 at the last follow-up (P < 0.05). Bone fusion was confirmed in 56 patients at 3-6 months postoperatively. CONCLUSIONS One-stage posterior transpedicular debridement, hemi-interbody and unilateral posterior bone grafting, and instrumentation are effective and feasible treatment methods for thoracic spinal tuberculosis.
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Affiliation(s)
- Yan Liu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Qingshan Liu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Xuzhou Duan
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Wentao Wang
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Lianjie Pu
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Beier Luo
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China
| | - Dawei He
- Department of Orthopedics, Shanghai Changhai Hospital, 168 Changhai Road, Shanghai, 200433, People's Republic of China.
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Li Y, Fei L, Shi J. Efficacy of posterior fixation and bone graft fusion for treatment of lumbar brucellosis spondylitis. Medicine (Baltimore) 2023; 102:e36577. [PMID: 38115351 PMCID: PMC10727668 DOI: 10.1097/md.0000000000036577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
The purpose of this study is to verify whether early stage patients with single-segment lumbar Brucella spondylitis can still be cured through simple posterior fixation and bone grafting, even without debridement. A retrospective study was conducted on 63 patients diagnosed with single-segment lumbar brucellosis spondylitis, who underwent posterior-only debridement (or not), bone grafting, and instrumentation from June 2016 to June 2019. Group A comprised 34 patients who did not undergo debridement, while group B comprised 29 patients who underwent debridement. The clinical data and imaging results of the patients were compared between the 2 groups to evaluate the clinical effects of debridement or not. Both groups of patients completed at least 1 year of follow-up. The group A had significantly lower values for operation time, blood loss, and hospital stay compared to the group B (P < .05). There were no significant differences between the 2 groups in terms of erythrocyte sedimentation rate, C-reactive protein, visual analogue scores, improvement of Japanese Orthopaedic Association Evaluation of treatment score, and Cobb angle. The bone fusion rate was 92% (31 patients) in group A and 96% (28 patients) in group B, with no significant difference between the 2 groups (P > .05). In summary, these findings suggest that posterior fixation and bone graft fusion are effective treatments for single-segment lumbar brucellosis spondylitis in early stages even without debridement. Importantly, these procedures offer several benefits, such as minimal trauma, short operation times, rapid postoperative recovery, and favorable bone graft fusion outcomes.
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Affiliation(s)
- Yu Li
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Le Fei
- Ningxia Medical University, Department of Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Jiandang Shi
- Ningxia Medical University, Department of Spine Orthopedics, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
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Duan D, Cui Y, Gong L, Fan Y, Liu J, Zhou Y, Li W. Single Posterior Surgery Versus Combined Posterior-Anterior Surgery for Lumbar Tuberculosis Patients. Orthop Surg 2023; 15:868-877. [PMID: 36655386 PMCID: PMC9977579 DOI: 10.1111/os.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE Posterior approach of debridement, interbody graft, and instrumentation, and combined posterior-anterior approach of posterior instrumentation and anterior debridement and interbody graft are two essential surgeries for the surgical treatment of spinal tuberculosis (TB), and, until now, which one should be chosen is still controversial. This study aimed to compare the therapeutic efficacy between the single posterior surgery and combined posterior-anterior surgery for lumbar tuberculosis (LTB) patients to elucidate the role of debridement and the effects that result from posterior structure resection. METHODS One hundred and nineteen LTB patients managed with single posterior debridement, interbody graft, and instrumentation surgery (Group P, 73 cases), or combined posterior-anterior surgery of posterior instrumentation and anterior debridement and interbody graft (Group P-A, 46 cases) from January 2008 to December 2016 were retrospectively analyzed. Different indexes were compared between the two groups to evaluate the curative effect and explore the role of debridement and the effects that result from posterior structure resection: operation time, blood loss, visual analog scale (VAS), Japanese Orthopaedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), surgical complication type and rate, spinopelvic sagittal parameters (local kyphosis [LK], pelvic incidence [PI] and pelvic tilt [PT], lumbar lordosis [LL], and sacral slope [SS]), drainage retention duration, hospital stay, time of abscess disappearance, time of activity recovery, and time of bone graft fusion by t-test or χ2 test. RESULTS The follow-up period ranged from 24 to 60 months. No significant variations were detected between the two groups for age, sex ratio, BMI, disease duration, indication, and the preoperative values of VAS, JOA, ESR, CRP, and LK (p > 0.05). The VAS, JOA, ESR, and CRP significantly improved in both groups after the operation (p < 0.05), along with the LK and LL (p < 0.05). Meanwhile, the SS, PI, and PT showed minor improvement after the operation (p > 0.05). Compared to the P-A group, the P group had shorter operation time and less blood loss and hospital stay (p < 0.05). However, both groups presented similar VAS, JOA, ESR, CRP, and LK improvements (p > 0.05). Additionally, the surgical complication type and rate, postoperative spinopelvic sagittal parameters, and bone graft fusion time did not differ between the two groups (p > 0.05). On the other hand, the patients in the P-A group had a shorter time of abscess disappearance and activity recovery (p < 0.05) but a similar time of drainage retention (p > 0.05) compared to the P group. CONCLUSION Both single posterior and combined posterior-anterior surgeries presented a good therapeutic effect for LTB patients with a low surgical complication rate and good quality of LK correction and LL reconstruction and maintenance. Moreover, single posterior surgery was less traumatic than combined posterior-anterior surgery but with slower TB lesion healing and activity recovery. Compared to debridement, stability seems to be more vital for STB healing, posterior structure resection does not affect the effect of spinopelvic realignment.
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Affiliation(s)
- Dapeng Duan
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yaqing Cui
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Liqun Gong
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yayi Fan
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Jun Liu
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Yongchun Zhou
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
| | - Weiwei Li
- Department of OrthopedicShaanxi Provincial People's HospitalXi'anChina,Xi'an Medical UniversityXi'anChina
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Mansour M, Tanta N, Ismail G, Alsuliman T, Salman I. A complex surgery of spinal tuberculosis with a psoas abscess accompanied by fibula autografting: an alternative treatment of Pott's disease. J Surg Case Rep 2023; 2023:rjac635. [PMID: 36636651 PMCID: PMC9831644 DOI: 10.1093/jscr/rjac635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023] Open
Abstract
The most common manifestation of skeletal tuberculosis is tuberculosis spondylitis. Symptoms may progress insidiously from back pain to cause many severe complications. Early diagnosis and management of spinal tuberculosis have special importance in prevention. We report a case of a 24-year-old female who was diagnosed with tuberculous spondylitis, complicated with psoas abscess and grade 1/5 of lower limb weakness. The patient was treated with anti-tuberculous drugs and underwent surgical debridement, interbody fusion and internal fixation accompanied by fibular autografting using a posterior-only approach and supplemental posterior spinal stabilisation on an infected background. Within 14 years of follow-up, full bone graft spinal fusion has been achieved with no major complications. According to its clinical efficacy and feasibility, this procedure is suggested to be an alternative treatment for Pott's disease.
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Affiliation(s)
- Marah Mansour
- Correspondence address. Faculty of Medicine, Tartous University, Tartous, Syrian Arab Republic. Tel: +963997527302; E-mail:
| | - Nour Tanta
- Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic
| | - Ghina Ismail
- Faculty of Medicine, Tartous University, Tartous 0000, Syrian Arab Republic
| | - Tamim Alsuliman
- Hôpital Saint Antoine, Rue de Faubourg Saint Antoine, Paris 75012, France
| | - Issam Salman
- Department of Neurosurgery, AlHikma Hospital, Tartous 0000, Syrian Arab Republic
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Posterior limited unilateral fenestration approach for treating patients with single-segment thoracic and lumbar tuberculosis. Acta Neurochir (Wien) 2022; 164:2637-2644. [PMID: 36070003 DOI: 10.1007/s00701-022-05342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 08/06/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Posterior limited unilateral fenestration approach is extensively used in the treatment of many spinal diseases. But whether it is suitable for spinal tuberculosis (TB) is rarely reported. Hence, the current study evaluated the feasibility and efficacy of the posterior limited unilateral fenestration (PLUF) debridement, bone grafting fusion, and instrumentation to treat single-segment thoracic and lumbar TB. METHODS Eighty-three patients (45 male and 38 female) aged 17-79 years old with the single-segment thoracic and lumbar TB who underwent PLUF debridement, bone grafting fusion, and instrumentation from our hospital were recruited for this study. The operation time, blood loss volume, postoperative complication rate, kyphotic Cobb angle, neurological functional improvement defined by the American Spinal Injury Association (ASIA) classification, the visual analogue scale (VAS) score, and the bone fusion time were utilized for assessing the clinical feasibility and efficacy. RESULTS The average follow-up time was 46.9 ± 13.1 (24-72) months. At the last follow-up, the mean kyphotic Cobb angle was significantly reduced from preoperative 23.0° ± 15.3° to postoperative 8.3° ± 11.0° (p < 0.001). Based on the ASIA classification, 89.2% (33 out of 37) patients with preoperative neurological impairment indicated good neurological improvement after the surgery. The VAS pain score significantly decreased from preoperative 6.9 ± 1.1 to 1.3 ± 0.7 3 months after operation (p < 0.001). All the patients achieved solid bony fusion within 13 months of surgery. CONCLUSIONS For patients with single-segment thoracic and lumbar TB, PLUF debridement, bone grafting fusion, and instrumentation are a feasible and effective surgical treatment.
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Jiang L, Sheng X, Deng Z, Gao Q, Liu S. A comparative study of one-stage posterior unilateral limited laminectomy vs. bilateral laminectomy debridement and bone grafting fusion combined with internal fixation for the treatment of aged patients with single-segment spinal tuberculosis. BMC Musculoskelet Disord 2022; 23:619. [PMID: 35761205 PMCID: PMC9238245 DOI: 10.1186/s12891-022-05562-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022] Open
Abstract
Study design This is a retrospective study. Background To assess and compare the clinical outcomes of posterior unilateral limited laminectomy (ULL) or bilateral laminectomy (BL) debridement and bone grafting fusion combined with internal fixation among aged patients with single-segment thoracic and lumbar tuberculosis (SST/LTB). Materials and methods We performed a retrospective study on aged patients (age > 65 years old) with SST/LTB from January 2010 to October 2018. We reviewed 36 aged patients who were treated with BL and 31 aged patients treated with ULL. All participants had undergone and finished a three-year follow-up. The outcomes were evaluated by the improvement of neurological function, correction Cobb angle, bone fusion time, and back pain, as well as operative time, blood loss, hospital stay, and postoperative complications. Results The operative time, blood loss volume, and incidence of complications in group B were significantly less than those in group A (P < 0.01). The postoperative kyphotic angle in both groups was reduced significantly compared to the preoperative status (P < 0.01). The percentage of neurological improvement was 92.9% in group A and 90.9% in group B. All patients achieved solid bone fusion after surgery. At three-year follow-up, the angle loss in group B was significantly less than that in group A (P < 0.01); Furthermore, patients in group B had a lower average visual analog scale score of back pain and Oswestry Disability Index score than patients in group A (P < 0.05). Conclusions For aged patients with SST/LTB, ULL is a safer and more effective surgical treatment than BL.
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Xu S, Zhang S, Wang G, Yang J, Song Y, Wang Q. Comparison of clinical and radiological outcomes of local morselized bone grafts and structural iliac bone grafts in the treatment of lumbar tuberculosis with posterior-only surgery. BMC Surg 2022; 22:184. [PMID: 35568944 PMCID: PMC9107644 DOI: 10.1186/s12893-022-01638-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/09/2022] [Indexed: 02/08/2023] Open
Abstract
Background Many surgeons have reported results similar to those of anterior debridement and bone grafting in treating spinal tuberculosis in the lumbar region using only a posterior approach. However, there is still no consensus regarding bone graft methods. This study aims to compare the clinical and radiological outcomes of morselized versus structural iliac bone grafts in the treatment of lumbar tuberculosis via one-stage posterior surgery. Methods A retrospective study was performed with 82 patients with lumbar tuberculosis who had undergone posterior-only debridement, bone grafting, and instrumentation between January 2014 and June 2018. Morselized bone grafts were used in 43 patients, whereas structural iliac bone grafts were used in 39 patients. The clinical data and imaging results of the patients were compared between the two groups to evaluate the clinical effects of the two types of grafts. Results The operation time, blood loss and hospital stay values in the morselized bone group were significantly lower than those in the structural iliac bone group (p < 0.05). No significant differences were observed with respect to erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Cobb angle, or improvement of neurological function between the two groups. The VAS pain scores for low back and leg pain decreased significantly after the operation (p < 0.05). However, postoperatively, the VAS score was higher in the structural iliac bone group than in the morselized bone group, and there was no significant difference at the last follow-up between the two groups (p > 0.05). Bone fusion was achieved in 41 patients (95%) in the morselized bone group and 38 patients (97%) in the structural iliac bone group. There was no significant difference between the fusion rates of the two groups (p > 0.05). Conclusion The two graft techniques achieved comparable clinical outcomes in lumbar spinal tuberculosis treatment. However, the morselized bone graft was more beneficial in terms of reducing surgical trauma and postoperative complications.
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Affiliation(s)
- Shuang Xu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 646000, Sichuan Province, China.,Department of Orthopaedic Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 of TaiPing Road, Luzhou, 646000, Sichuan Province, China
| | - Shuai Zhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 of TaiPing Road, Luzhou, 646000, Sichuan Province, China
| | - Gaoju Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 of TaiPing Road, Luzhou, 646000, Sichuan Province, China
| | - Jin Yang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 of TaiPing Road, Luzhou, 646000, Sichuan Province, China
| | - Yueming Song
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 646000, Sichuan Province, China.
| | - Qing Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Southwest Medical University, No. 25 of TaiPing Road, Luzhou, 646000, Sichuan Province, China.
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Zhan Y, Kang X, Gao W, Zhang X, Kong L, Hao D, Wang B. Efficacy analysis of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments with minimum 5-year follow-up. Sci Rep 2022; 12:149. [PMID: 34997091 PMCID: PMC8742094 DOI: 10.1038/s41598-021-04138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/09/2021] [Indexed: 11/25/2022] Open
Abstract
In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4–6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4–6 segments. 67 patients with tuberculosis in T4–6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4–6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.
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Affiliation(s)
- Yi Zhan
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China.,Shaanxi University of Chinese Medicine, Xi'an, 712046, China
| | - Xin Kang
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China
| | - Wenjie Gao
- Department of Spine Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, 510120, China
| | - Xinliang Zhang
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China
| | - Lingbo Kong
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China
| | - Dingjun Hao
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China
| | - Biao Wang
- Department of Spine Surgery, Xi'an Jiaotong University College of Medicine, Honghui Hospital, Xi'an, 710054, Shaanxi, China.
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Ohata H, Prakasa D, Goto H, Ohata K, Goto T, Nishikawa M. Two-stage posterior decompression and fusion for tuberculous spondylitis after intravesical bacillus Calmette-Guerin instillation. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:318-321. [PMID: 34729001 PMCID: PMC8501809 DOI: 10.4103/jcvjs.jcvjs_201_20] [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] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
Intravesical bacillus Calmette-Guerin (BCG) instillation is an effective treatment for nonmuscle invasive superficial bladder cancer. BCG induces a massive influx of inflammatory cells and production of cytokines in the bladder mucosa and lumen that leads to an immune response against tumor cells, acting as an immunotherapy. Cystitis, bladder ulceration, and bladder contracture are known local genitourinary complications, whereas systemic complications such as miliary pulmonary tuberculosis, mycotic aneurysms, tuberculous spondylodiscitis, and granulomatous hepatitis are very rare. A case of tuberculous spondylodiscitis at the T8 and T9 levels following intravesical BCG instillation for bladder carcinoma is reported. The patient initially underwent decompressive laminectomy for spastic paraparesis. After reporting improvement for few weeks, the patient again presented with similar complaints and was found to have an increased kyphotic deformity, for which he underwent fixation surgery.
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Affiliation(s)
- Hiroki Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - David Prakasa
- Department of Neurosurgery, Bali Mandara General Hospital, Denpasar, Bali, Indonesia
| | - Hiroyuki Goto
- Department of Neurosurgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Kenji Ohata
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takeo Goto
- Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Misao Nishikawa
- Department of Neurosurgery, Moriguchi-Ikuno Memorial Hospital, Osaka, Japan
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Long W, Gong L, Cui Y, Qi J, Duan D, Li W. Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB). BMC Musculoskelet Disord 2020; 21:606. [PMID: 32912166 PMCID: PMC7488496 DOI: 10.1186/s12891-020-03628-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes. METHODS Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb's angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients. RESULTS The patients were followed up for 20-48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120-280 min), whereas 818.0 ml of blood was lost (range, 400-1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = - 11.6, P<0.01). The preoperative kyphotic Cobb's angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = - 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6-16 months). CONCLUSION Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.
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Affiliation(s)
- Weihong Long
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Liqun Gong
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Yaqing Cui
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Jie Qi
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Dapeng Duan
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Weiwei Li
- Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, 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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Li W, Liu Z, Xiao X, Zhang Z, Wang X. Comparison of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic spinal tuberculosis in adults. BMC Musculoskelet Disord 2019; 20:570. [PMID: 31775707 PMCID: PMC6882028 DOI: 10.1186/s12891-019-2945-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/13/2019] [Indexed: 11/25/2022] Open
Abstract
Background The surgical procedures for mid-thoracic spinal tuberculosis mainly include anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion. Until now, the surgical choice is still controversial. This study aims to compare the clinical efficacy of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic (T5–9) spinal tuberculosis in adult patients. Methods Eighty-seven cases with mid-thoracic spinal tuberculosis were treated with anterior transthoracic debridement and fusion (Group A, n = 39) and posterior transpedicular debridement and fusion (Group B, n = 48) from January 2007 to June 2014. Parameters including the operation time, blood loss, time of ESR and CRP decreasing to the normal level, time of abscess disappearance, time of bone graft fusion, rate of surgical complications, Visual Analog Scale (VAS) score, kyphosis angle and SF-36 scale were compared between two groups to evaluate their therapeutic effects. Results All patients were followed up for 5–10 years with the mean of 6.2 ± 1.1 years. No significant differences were observed regarding the gender composition ratio, age, course of disease, number of lesion segments, and preoperative indexes of ESR, CRP, VAS score, kyphosis angle and SF-36 scale between the two groups. Besides, no significant differences were observed regarding VAS score, kyphosis angle and SF-36 scale between the two groups in the 5th postoperative year (P > 0.05). However, the operation time (158.2 ± 10.7 min vs. 183.7 ± 14.1 min), blood loss (517.9 ± 76.5 ml vs.714.6 ± 57.4 ml), time of ESR (2.3 ± 1.1 months vs.3.1 ± 1.4 months) and CRP (1.1 ± 0.3 months vs.1.2 ± 0.6 months) decreasing to the normal level, time of abscess disappearance (2.7 ± 1.6 months vs.4.9 ± 1.9 months), and time of bone graft fusion (6.6 ± 0.8 months vs.8.0 ± 9.6 months) in Group A were less than those in Group B (P < 0.05). Conclusions Both anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion have a low risk of surgical complications and provide good quality of life for the patients with mid-thoracic (T5–9) spinal tuberculosis followed up in the mid-term. Moreover, the anterior procedure leads to early resolution of the disease and faster fusion.
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Affiliation(s)
- Weiwei Li
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China.,Department of Orthopedic, Shaanxi Provincial People's Hospital, Xi'an, 710068, Shaanxi, China
| | - Zheng Liu
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China
| | - Xiao Xiao
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China
| | - Zhen Zhang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China.,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China
| | - Xiyang Wang
- Department of Spine Surgery, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China. .,Hunan Engineering Laboratory of Advanced Artificial Osteo-materials, Xiangya Hospital, Central South University, 87#Xiangya Road, Changsha, 410008, Hunan, China.
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13
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Liao Y, Ye R, Tang Q, Tang C, Ma F, Luo N, Zhong D. Is It Necessary to Perform the Second Surgery Stage of Anterior Debridement in the Treatment of Spinal Tuberculosis? World Neurosurg 2019; 134:e956-e967. [PMID: 31756501 DOI: 10.1016/j.wneu.2019.11.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this retrospective comparative study, the efficacy and clinical outcomes of long posterior instrumentation, with or without laminectomy, were evaluated and the necessity of the second stage of anterior debridement in the treatment of spinal tuberculosis (TB) was discussed. METHODS This retrospective study included 41 patients who were diagnosed with spinal TB between January 2010 and June 2016. A total of 18 patients had received long posterior instrumentation, with or without laminectomy (group A), whereas the other 23 patients had posterior instrumentation plus anterior debridement and autogenous bone grafting (group B). The surgical information, clinical effectiveness, laboratory tests, and imaging results were compared between the 2 groups. RESULTS One patient in group B died. Sinus drainage and incomplete bone fusion were discovered 1 year postoperatively. TB symptoms were significantly improved after surgery compared with those before surgery (P < 0.05), and there was no significant difference in the treatment efficacy between the 2 groups at the final follow-ups (P > 0.05). Compared with those of group B, the surgical time, bed-rest time, and hospitalization time of group A were all significantly shorter (P < 0.05), whereas the times before abscesses disappeared, bone graft fusion, and erythrocyte sedimentation rate returning to normal were all significantly longer (P < 0.05). CONCLUSIONS Single-stage long posterior instrumentation, with or without laminectomy, is a safe, effective, and feasible method for the treatment of spinal TB. The second stage of anterior debridement surgery may not be necessary for every spinal TB treatment.
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Affiliation(s)
- Yehui Liao
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Rupei Ye
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiang Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chao Tang
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Ma
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ning Luo
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Dejun Zhong
- Department of Spine Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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14
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Zhou Y, Li W, Liu J, Gong L, Luo J. Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis. BMC Surg 2018; 18:71. [PMID: 30176880 PMCID: PMC6122740 DOI: 10.1186/s12893-018-0405-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 08/28/2018] [Indexed: 11/24/2022] Open
Abstract
Background To compare the clinical efficacy of single posterior debridement, bone grafting and instrumentation with that of single-stage anterior debridement, bone grafting and posterior instrumentation for treatment of adult patients with thoracic and thoracolumbar spinal tuberculosis (TB). Methods We performed a retrospective analysis of 64 adult patients with thoracic and thoracolumbar spinal TB who underwent surgery between January 2011 and December 2014. Of the 64 patients, 34 patients were treated using a single posterior-only approach (posterior debridement, bone grafting and instrumentation; Group A). Thirty patients were treated with a combined anterior and posterior approach (single-stage anterior debridement, bone grafting and posterior instrumentation; Group B). Clinical manifestations, laboratory and imaging results were subjected to statistical analysis. Results The mean (±standard deviation) duration of follow-up was 16.8 ± 1.4 months (range, 10–34). Bony fusion was achieved in all the bone grafts with no loosening or breakage of internal fixation. In both of the groups, the visual analog scale (VAS) pain score, ESR and CRP at 6 weeks after operation and at the most recent follow-up were significantly lower than the preoperative level (p < 0.05). The operation time, intraoperative blood loss and length of hospital stay in group A were significantly less than those in group B (P < 0.05). As of most recent follow-up, no significant between-group difference was observed with respect to the American Spinal Injury Association classification status (p > 0.05). Furthermore, no significant between-group difference was observed with respect to preoperative kyphosis angle, and postoperative angle correction and angle correction rate (P > 0.05). One patient in group A relapsed 20 months after operation, and was successfully treated with debridement using the combined anterior and posterior approach. Conclusion Single posterior debridement, bone grafting and instrumentation for treatment of thoracic and thoracolumbar spinal TB can achieve similar curative effect as that with single-stage anterior debridement, bone grafting and posterior instrumentation, and is associated with additional advantages of shorter operation time, less bleeding and shorter length of hospital stay.
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Affiliation(s)
- Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Weiwei Li
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China.
| | - Jun Liu
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Liqun Gong
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Jing Luo
- Department of Nursing administration, Honghui Hospital, Xi'an Jiaotong University College of Medicine, 555# You-yi East Road, Xi'an, 710054, Shaanxi, People's Republic of China.
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15
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Liu F, Chen Z, Lou C, Yu W, Zheng L, He D, Zhu K. Anterior reconstruction versus posterior osteotomy in treating Kümmell's disease with neurological deficits: A systematic review. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2018; 52:283-288. [PMID: 29803679 PMCID: PMC6146012 DOI: 10.1016/j.aott.2018.05.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 03/29/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to conduct a systematic review of literature comparing the clinical effectiveness and safety between anterior reconstruction (AR) and posterior osteotomy (PO) in the treatment of Kümmell's disease with neurological deficits. METHODS We systematically reviewed the literature in PubMed, EMBASE, Cochrane Database of Systematic Reviews, and the Web of Science for "spin*," "surg*," "Kümmell's disease," "Kummell's disease," "Kummell disease," "vertebral osteonecrosis," "vertebral pseudarthrosis," "intravertebral vacuum cleft," "delayed vertebral collapse," and "compression fracture nonunion". Quality was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation method. RESULTS A total of 10 publications involving 268 Kümmell's disease patients with neurological deficits were included in this review, with 7 studies of low- or very low-quality. There were 37.7% and 62.3% of patients receiving AR and PO, respectively. For clinical outcomes, AR group showed no significant differences in pain, neurological dysfunction, and imaging outcome improvements compared with patients who underwent PO. However, the incidence of implant-related complications including loose screw, screw fracture, screw disconnection, and plate dislodgment, was higher in AR group compared with PO group (21.6% vs. 14.3%). As another major complication, AR group more often required a second surgery. CONCLUSION This systematic review demonstrated that both AR and PO could improve pain, neurological dysfunction and imaging outcomes. However, serious comorbidities, multilevel corpectomies and/or severe osteoporosis highly required PO. Design discrepancies were found in the current studies, further higher-quality studies are warranted. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Feijun Liu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Zhenzhong Chen
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Chao Lou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Weiyang Yu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Lin Zheng
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Dengwei He
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
| | - Kejun Zhu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui, Zhejiang, People's Republic of China.
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Abstract
Tuberculosis (TB) remains endemic in many parts of the developing world and is increasingly seen in the developed world due to migration. A total of 1.3 million people die annually from the disease. Spinal TB is the most common musculoskeletal manifestation, affecting about 1 to 2% of all cases of TB. The coexistence of HIV, which is endemic in some regions, adds to the burden and the complexity of management. This review discusses the epidemiology, clinical presentation, diagnosis, impact of HIV and both the medical and surgical options in the management of spinal TB. Cite this article: Bone Joint J 2018;100-B:425-31.
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Affiliation(s)
- R N Dunn
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - M Ben Husien
- University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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17
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Broderick C, Hopkins S, Mack DJF, Aston W, Pollock R, Skinner JA, Warren S. Delays in the diagnosis and treatment of bone and joint tuberculosis in the United Kingdom. Bone Joint J 2018; 100-B:119-124. [DOI: 10.1302/0301-620x.100b1.bjj-2017-0357.r1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aims Tuberculosis (TB) infection of bones and joints accounts for 6.7% of TB cases in England, and is associated with significant morbidity and disability. Public Health England reports that patients with TB experience delays in diagnosis and treatment. Our aims were to determine the demographics, presentation and investigation of patients with a TB infection of bones and joints, to help doctors assessing potential cases and to identify avoidable delays. Patients and Methods This was a retrospective observational study of all adults with positive TB cultures on specimens taken at a tertiary orthopaedic centre between June 2012 and May 2014. A laboratory information system search identified the patients. The demographics, clinical presentation, radiology, histopathology and key clinical dates were obtained from medical records. Results A total of 31 adult patients were identified. Their median age was 37 years (interquartile range (IQR): 29 to 53); 21 (68%) were male; 89% were migrants. The main sites affected were joints (10, 32%), the spine (8, 26%) and long bones (6, 19%); 8 (26%) had multifocal disease. The most common presenting symptoms were pain (29/31, 94%) and swelling (26/28, 93%). ‘Typical’ symptoms of TB, such as fever, sweats and weight loss, were uncommon. Patients waited a median of seven months (IQR 3 to 13.5) between the onset of symptoms and referral to the tertiary centre and 2.3 months (IQR 1.6 to 3.4.)) between referral and starting treatment. Radiology suggested TB in 26 (84%), but in seven patients (23%) the initial biopsy specimens were not sent for mycobacterial culture, necessitating a second biopsy. Rapid Polymerase Chain Reaction-based testing for TB using Xpert MTB/RIF was performed in five patients; 4 (80%) tested positive for TB. These patients had a reduced time between the diagnostic biopsy and starting treatment than those whose samples were not tested (median eight days versus 36 days, p = 0.016). Conclusion Patients with bone and joint TB experience delays in diagnosis and treatment, some of which are avoidable. Maintaining a high index of clinical suspicion and sending specimens for mycobacterial culture are crucial to avoid missing cases. Rapid diagnostic tests reduce delays and should be performed on patients with radiological features of TB. Cite this article: Bone Joint J 2018;100-B:119–24.
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Affiliation(s)
- C. Broderick
- Directorate of Infection, Royal Free London
NHS Foundation Trust, Pond Street, London
NW3 2QG, UK
| | - S. Hopkins
- Directorate of Infection, Royal Free London
NHS Foundation Trust and Royal National Orthopaedic Hospital NHS
Trust, Pond Street, London
NW3 2QG, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - D. J. F. Mack
- Directorate of Infection, Royal Free London
NHS Foundation Trust and Royal National Orthopaedic Hospital NHS
Trust, Pond Street, London
NW3 2QG, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - W. Aston
- Royal National Orthopaedic Hospital NHS
Trust, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - R. Pollock
- Royal National Orthopaedic Hospital NHS
Trust, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - J. A. Skinner
- Royal National Orthopaedic Hospital NHS
Trust, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
| | - S. Warren
- Directorate of Infection, Royal Free London
NHS Foundation Trust and Royal National Orthopaedic Hospital NHS
Trust, Pond Street, London
NW3 2QG, Brockley Hill, Stanmore, Middlesex
HA7 4LP, UK
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