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Wu W, Wang S, Li Z, Lin R, Lin J. Posterior-only approach with titanium mesh cages versus autogenous iliac bone graft for thoracic and lumbar spinal tuberculosis. J Spinal Cord Med 2021; 44:598-605. [PMID: 31663833 PMCID: PMC8288125 DOI: 10.1080/10790268.2019.1675953] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: This study aimed to compare the effectiveness of titanium mesh cages (TMCs) with autogenous iliac bone grafts (AIBG) in posterior-only surgery for thoracic and lumbar spinal tuberculosis.Design: Retrospective investigative design.Setting: The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.Participants: A total of 146 patients with thoracic or lumbar tuberculosis.Interventions: All patients underwent a posterior-only approach with either a TMC (86 cases) or AIBG (60 cases).Outcomes measures: Operation duration, intraoperative blood loss, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), visual analogue scale (VAS), and related complications were used to compare the effectiveness and feasibility of the two techniques. Frankel grading system, Cobb angle, and loss of angular correction were employed to assess neurological and kyphotic improvements.Results: There were significant improvements in ESR, CRP, VAS, Frankel grade, and Cobb angle at the last follow-up (P < 0.05) when compared with the preoperative state. The TMC group was superior in operation duration (P < 0.001), intraoperative blood loss (P = 0.007), VAS (P < 0.001), loss of angular correction (P < 0.001), and surgical complications as compared with the AIBG group. There were no significant differences in the improvement of the Frankel grade and Cobb angle between the TMC and AIBG groups (P > 0.05). A recurrence of tuberculosis was not found in either of the groups.Conclusion: Compared to autogenous iliac bone grafts, titanium mesh cages could serve as a superior material in posterior-only operative therapy for thoracic and lumbar spinal tuberculosis.
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Affiliation(s)
- Wence Wu
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Shenglin Wang
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Zhechen Li
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Renqin Lin
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China
| | - Jianhua Lin
- Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, People’s Republic of China,Correspondence to: Jianhua Lin, Department of Spinal Surgery, The First Affiliated Hospital of Fujian Medical University, Chazhong Road 20th, Fuzhou, Fujian350005, People’s Republic of China; Ph: +86 13506999818.
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Garcia PBL, Silva LECTD, Barros AGCD, Almeida LEPCAD. POSTERIOR VERTEBRAL COLUMN RESECTION (PVCR): A SAFE AND EFFECTIVE OPTION TO TREAT KYPHOSIS FROM SPINAL TUBERCULOSIS. COLUNA/COLUMNA 2021. [DOI: 10.1590/s1808-185120212001235064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the clinical and radiological results of posterior vertebral column resection (PVCR) for the treatment of kyphosis from spinal tuberculosis. Methods: Retrospective study of a series of 14 cases, 9 female and 5 male, with a mean age of 28 years (1 to 64) at the time of surgery, with spinal tuberculosis with mean kyphosis of 56.42° (2° to 95°). Results: All patients underwent surgical treatment with PVCR, with a mean number of 2.57 (1 to 6) resected vertebrae and a mean number of instrumented vertebrae of 6.14 (4 to 8). The mean kyphosis correction was 64% after up to one year of follow-up. Prior to surgery, eight patients had signs of spinal cord impairment (ASIA score ranging from A to D), and six did not present any deficit of strength or sensory function (ASIA E). There was no neurological worsening and everyone with deficits improved by at least one degree on the scale. In the postoperative follow-up, bone consolidation was observed in all patients, except one. Among the intra- and postoperative complications, pleurotomy was the most prevalent. Conclusion: Posterior vertebral column resection has proven to be a safe and effective option for the treatment of kyphotic deformity from spinal tuberculosis. Level of evidence IV; Therapeutic studies - Investigation of treatment results.
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Yi Z, Song Q, Zhou J, Zhou Y. The efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis. Sci Rep 2021; 11:3591. [PMID: 33574379 PMCID: PMC7878885 DOI: 10.1038/s41598-021-83178-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/25/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis in adult patients. A retrospective analysis was conducted between June 2013 and September 2017of 88 adult patients with thoracic spinal tuberculosis. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imageological results were subsequently analysed. All patients were followed for 40.6 ± 4.1 months (range, 36–48 m). Bony fusion was achieved in all bone grafts of thoracic vertebrae. The visual analogue scale scores, erythrocyte sedimentation rate and C-reactive protein levels 6 weeks after surgery and at the final follow up were significantly lower than the preoperative levels (P < 0.05). The postoperative and final follow up kyphosis angles were both significantly smaller than the preoperative kyphosis angles (P < 0.05). The postoperative angle correction rate reached 81.5% and the postoperative angle loss reached only 4.1%. At the last follow up, American Spinal Injury Association improvement was significant, compared with the preoperative levels (P < 0.05). The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.
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Affiliation(s)
- Zhi Yi
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China
| | - Qichun Song
- Department of Orthopedic, 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Jiao Zhou
- Department of Surgery Center, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, People's Republic of China
| | - Yongchun Zhou
- Department of Orthopedic, Shaanxi Provincial People's Hospital, 256# You-yi West Road, Xi'an, 710068, Shaanxi, People's Republic of China.
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Wu Y, Feng P, Kong Q, Wang Y, Hu Y, Guo C, Wu H. Treatment of Lumbosacral Tuberculosis with Significant Vertebral Body Loss Using Single-Stage Posterior Surgical Management with a Structural Autograft Combined with a Titanium Mesh Cage. World Neurosurg 2020; 148:e10-e16. [PMID: 33249222 DOI: 10.1016/j.wneu.2020.11.104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Treatment of lumbosacral tuberculosis is still controversial. In our study, we assessed the efficacy and feasibility of single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation for the treatment of lumbosacral tuberculosis with significant vertebral body loss. METHODS From May 2011 to June 2018, 15 patients with lumbosacral tuberculosis with significant vertebral body loss had undergone single-stage posterior debridement, interbody fusion using a structural autograft combined with a titanium mesh cage, and posterior instrumentation. The pre- and postoperative lumbosacral angle, visual analog scale score, erythrocyte sedimentation rate, C-reactive protein, and neurological status were assessed. RESULTS Surgery was successful for all patients, and no patient experienced tuberculosis recurrence during an average follow-up period of 27.3 months (range, 12-60 months). After surgery, the erythrocyte sedimentation rate and C-reactive protein for all patients had returned to normal within 3 months. At the final follow-up examination, the neurological status had improved in all patients who had had neurological deficits preoperatively. The mean preoperative lumbosacral angle was 12.6° (range, 6.7°-17.9°), and had increased to 27.7° (range, 24.3°-34.6°) after surgery. The average lumbosacral angle was 26.4° (range, 22.1°-32.3°), with an average loss of 1.4° (range, 0.6°-2.3°) at the final follow-up visit. CONCLUSIONS The combination of single-stage posterior debridement, interbody fusion using structural autografts with a titanium mesh cage, and posterior instrumentation is an effective and safe option for the treatment of lumbosacral tuberculosis with significant vertebral body loss.
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Affiliation(s)
- Ye Wu
- Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Pin Feng
- Orthopaedic Department, Hospital of Chengdu, Office of People's Government of Tibetan Autonomous Region, Chengdu, People's Republic of China
| | - Qingquan Kong
- Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China.
| | - Yu Wang
- Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yuan Hu
- Orthopaedic Department, Hospital of Chengdu, Office of People's Government of Tibetan Autonomous Region, Chengdu, People's Republic of China
| | - Chuan Guo
- Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Hao Wu
- Orthopaedic Department, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Yong LN, Ahmedy F, Yin KN, Engkasan JP. Functional Outcomes in Spinal Tuberculosis: A Review of the Literature. Asian Spine J 2020; 15:381-391. [PMID: 32951405 PMCID: PMC8217859 DOI: 10.31616/asj.2020.0086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Spinal tuberculosis often leads to neurological deficit and subsequent deterioration in functional outcomes. This review assesses the recent evidence on functional outcomes in spinal tuberculosis, highlighting functional recovery, assessment tools for functional measures, and associative factors for functional recovery. Using PubMed, a literature search was done using the terms “spinal tuberculosis,” “tuberculous spondylitis,” “tuberculous spondylodiscitis,” and “functional outcome” for original articles published between January 2010 and December 2019. A total of 191 search results were found. Detailed screening showed that 19 articles met the eligibility criteria: 13 of these focused on surgical methods, four on conservative management, and two on rehabilitation approaches. The outcome measures used for functional assessment were the Oswestry Disability Index (11 articles), Japanese Orthopaedic Association score (n=3), modified Barthel Index (n=2), Functional Independence Measure (n=2), and 36-item Short-Form Health Survey (n=1). Functional outcome was mainly affected by pain, spinal cord compression, and inpatient rehabilitation. No significant difference in functional outcome was found between conservative management and surgery for cases with uncomplicated spinal tuberculosis. Most studies focused on surgery as the mode of treatment and used pain-related functional measures; however, these assessed functional limitations secondary to pain, and not neurological deficits. Further studies may consider examining functional outcomes in spinal tuberculosis by utilizing spinal cord-specific functional outcome measures, to evaluate outcome measures as a prognostic tool, and to measure functional outcomes from specific rehabilitation interventions.
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Affiliation(s)
- Lionelson Norbert Yong
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Fatimah Ahmedy
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Khin Nyein Yin
- Faculty of Medicine & Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - Julia Patrick Engkasan
- Department of Rehabilitation Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Zhao C, Luo L, Pu X, Liu L, Li P, Liang L, Luo F, Hou T, Dai F, Xu J, Zhou Q. Transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis: Minimum 5-year follow-up. Medicine (Baltimore) 2020; 99:e20359. [PMID: 32481417 DOI: 10.1097/md.0000000000020359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the clinical and imaging results of transforaminal debridement with a posterior-only approach involving placement of an interbody bone graft combined with diseased vertebral fixation for the treatment of thoracic and lumbar tuberculosis (TB) with a minimum 5-year follow-up.Sixty-five patients who presented with active thoracic and lumbar TB between October 2006 and August 2013 were retrospectively analyzed: 20 were thoracic TB (group A), 17 were thoracolumbar TB (group B), and 28 were lumbar TB (group C). The patient data, operating time, blood loss, Visual Analog Scale score, Oswestry Disability Index score, correction of kyphosis, recovery of neurological function, and complications were recorded and analyzed.The patients were followed for 68.7 ± 17.8 months. The preoperative average Cobb angles of kyphosis in patients in groups A, B, and C significantly decreased from 28.2 ± 11.9°, 30.5 ± 16.9°, and 10.9 ± 8.8° before surgery to 8.0 ± 5.4°, 5.0 ± 4.1°, and -4.4 ± 1.6° (- indicates lordosis) after surgery, respectively. At the final follow-up time, the Cobb angles were 9.2 ± 6.1°, 6.8 ± 10.0°, and -3.7 ± 2.0°, respectively. The postoperative Cobb angles of kyphosis were significantly improved in all groups (P < .05). The correction loss angles were larger in groups A and B than in group C (P > .05). The operating time, blood loss, and complications were not significantly different between the groups (P > .05). Three (4.6%) patients developed unhealed TB during postoperative anti-TB treatment, and 6 patients (9.2%) with TB relapsed after healing from surgery.The posterior-only approach for the surgical treatment of thoracic and lumbar TB achieved satisfactory outcomes over long-term follow-up. The implantation of pedicle screws in diseased vertebrae reduced the range of fixation, but patients with thoracic and thoracolumbar TB should undergo fixation to at least 1 adjacent normal segment. There were some cases of recurrence after TB healed, and long-term follow-up is therefore necessary.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Lei Luo
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Xiaobing Pu
- Department of Orthopedic Surgery, No. 4 West China Teaching Hospital, Sichuan University, Chengdu, Sichuan
| | - Liehua Liu
- Graduate School, Ningxia Medical University, Yinchuan, Ningxia
| | - Pei Li
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Lichuan Liang
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, Chongqing, China
| | - Qiang Zhou
- Department of Orthopedics, The Third Affiliated Hospital of Chongqing Medical University (Gener Hospital), Chongqing
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He Z, Tang K, Gui F, Zhang Y, Zhong W, Quan Z. Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis. J Orthop Surg Res 2019; 14:288. [PMID: 31477144 PMCID: PMC6721193 DOI: 10.1186/s13018-019-1312-9] [Citation(s) in RCA: 4] [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: 06/21/2019] [Accepted: 08/09/2019] [Indexed: 11/26/2022] Open
Abstract
Background There was a controversy about bone grafting of spinal tuberculosis treatment. The aim of this study was to compare the clinical efficacy of a new bone grafting method—transverse bone grafting (TBG)—with iliac bone grafting (IBG) and titanium mesh grafting (TMG) in the treatment of single-segment thoracic spinal tuberculosis. Material and methods TBG was undertaken in 30 patients (group A), IBG was carried out in 28 patients (group B), and TMG was performed in 36 patients (group C). The operative time, intraoperative blood loss, postoperative drainage amount, postoperative complications, length of hospital stay, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score for back pain, Oswestry dysfunction index (ODI), intervertebral height, and time to bone graft fusion were compared. Changes in the Cobb angle of kyphosis, intervertebral height, and loss to the final follow-up were measured. Neurological function recovery was evaluated according to the criteria of the American Spinal Injury Association (ASIA). Results The operative times in group A was significantly shorter than those in groups B and C (PAB = 0.036, PAC = 0.005, PBC = 0.901). The hospital stay in group A was significantly shorter than that in groups B and C (PAB = 0.022, PAC = 0.031, PBC = 0.424). The intraoperative blood loss in group A was significantly less than that in groups B and C (PAB = 0.045, PAC = 0.004, PBC = 0.586). The VAS score, ODI, ESR level, CRP level, Cobb angle of kyphosis, and intervertebral height of the affected segment were significantly improved compared with those before surgery (P < 0.05). Conclusion For the treatment of single-segment thoracic spinal tuberculosis, the new interbody fusion technique using transverse process bone grafting is a safe, reliable, effective, and ideal bone grafting method.
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Affiliation(s)
- Zhongyuan He
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Ke Tang
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Fei Gui
- Department of Orthopedics, University-Town Hospital of Chongqing Medical University, Shapingba District, Chongqing, 401331, China
| | - Yuan Zhang
- Department of Orthopedics, Children's Hospital of Chongqing Medical University, Yuzhong District, Chongqing, 401122, China
| | - Weiyang Zhong
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China
| | - Zhengxue Quan
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Yuanjiagang, Yuzhong District, Chongqing, 400016, China.
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Wu W, Li Z, Wang S, Zhang H, Lin R, Lin J. One-Stage Surgical Treatment for Consecutive Multisegment Thoracic Spinal Tuberculosis with Kyphosis by Posterior-Only Debridement, Interbody Fusion, and Instrumentation. World Neurosurg 2019; 128:e238-e244. [DOI: 10.1016/j.wneu.2019.04.122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 10/27/2022]
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Zhang J, Wu X, Lu T, Song H, Zhou Z, Li B. [Application of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:296-301. [PMID: 30874384 PMCID: PMC8337913 DOI: 10.7507/1002-1892.201809090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/28/2019] [Indexed: 11/03/2022]
Abstract
Objective To evaluate the safety and effectiveness of one-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis. Methods Between August 2011 and October 2014, 13 patients with lumbosacral tuberculosis were treated by one-stage posterior reserved posterior ligament complex, lesion debridement, bone graft fusion, and internal fixation via unilateral musculussacrospinalis iliac flap approach. There were 8 males and 5 females, aged from 22 to 57 years, with an average age of 35 years. The disease duration ranged from 2 to 19 months, with an average of 6.7 months. According to the American Spinal Injury Association (ASIA) classification criteria, the patients were graded as grade B in 2 cases, grade C in 4 cases, grade D in 5 cases, and grade E in 2 cases before operation. The preoperative Oswestry disability index (ODI) was 36.4±5.7; the preoperative lumbosacral angle was (20.7±0.7)°; the preoperative erythrocyte sedimentation rate (ESR) was (63.4±8.4) mm/1 h; and the preoperative C-reactive protein (CRP) was (38.8±5.2) mmol/L. The operation time and intraoperative blood loss were recorded. The ODI, ASIA grade, lumbosacral angle, and ESR were recorded at last follow-up. Bridwell criterion was used to judge the interbody fusion. Results The operation time was 150-240 minutes (mean, 190 minutes), and the intraoperative blood loss was 420-850 mL (mean, 610 mL). No major blood vessel, dural sac, nerve root, and lumbosacral plexus injuries occurred during the operation. Delayed wound healing occurred in 3 cases, and primary wound healing achieved in the other patients. No wound infection or sinus formation was found. All 13 patients were followed up 1.5-6.1 years (mean, 2.8 years). During the follow-up period, there was no tubercular symptom, cerebrospinal fluid leakage, loosening and rupture of internal fixator; and no complications such as retrograde ejaculation and erectile dysfunction occurred in 8 male patients. Solid spinal fusion obtained in all patients with the mean fusion time of 6.4 months (range, 4.2-9.9 months); and all iliac osteotomies healed. At last follow-up, the ODI was 7.2±3.5, the lumbosacral angle was (31.2±0.5)°, and ESR was (9.8±2.5) mm/1 h, all of which improved significantly when compared with pre-operative ones ( P<0.05). The patients were classified as grade D in 2 cases and grade E in 11 cases, which improved significantly when compared with preoperative ones ( Z=-3.168, P=0.002). Conclusion One-stage posterior surgery via unilateral musculussacrospinalis iliac flap approach in treatment of lumbosacral tuberculosis is effective and safe.
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Affiliation(s)
- Jin Zhang
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Xinglin Wu
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Tingsheng Lu
- Department of Spinal Surgery, Guizhou Provincial Orthopedic Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Hui Song
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
| | - Zhuojia Zhou
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002,
| | - Bo Li
- Department of Orthopedics, Guizhou Provincial People's Hospital, Guiyang Guizhou, 550002, P.R.China
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Zhao C, Pu X, Zhou Q, Huang X, Zhang C, Luo L, Zhang Z, Hou T, Luo F, Dai F, Xu J. Can a posterior approach effectively heal thoracic and lumbar tuberculosis? Microbiology outcomes of the operative area. J Orthop Surg Res 2019; 14:24. [PMID: 30670055 PMCID: PMC6341735 DOI: 10.1186/s13018-019-1063-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/15/2022] Open
Abstract
Background There was a controversy about surgery approach of thoracic and lumbar tuberculosis (TB) treatment. The aim of this study was to compare the microbiology outcomes of the drainage liquid and the clinical outcomes of a posterior and anterior approach in the treatment of thoracic and lumbar TB. Materials and methods A total of 105 patients were enrolled in this prospective study from February 2011 to September 2015. Patients were divided into two groups: group A (51 patients, posterior approach surgery) and group B (54 patients, anterior approach surgery). Intraoperative TB samples were sent for Mycobacterium tuberculosis culture (MTBC). Drainage fluid was postoperatively collected for polymerase chain reaction (PCR), acid-fast strains (AFS), MTBC, and DNA molecular detection (DNAMD) analyses. Compare the drainage liquid positive rate of the two groups and estimate relationship between the positive results of drainage fluid and the lesion region. In addition, the clinical outcomes including the bony fusion, relapse rate, complications, and neurological status were collected. Results There was no significant difference in the positive rate of AFS, PCR, DNAMD, MTBC, or any positive rate (APR) of drainage liquid between the two groups (P > 0.05). In both groups, the MTBC-positive rate of postoperative drainage fluid was significantly lower than that of the intraoperative sample (P < 0.01). There was no significant relationship between APR and the lesion region (P > 0.05). All the patients had at least 2 years of follow-up, with an average of 34.4 ± 15.8 months. There were four patients in group A and two patients in group B who had recurrent spine TB, and the rest of the patients had fusion in the surgical area. There was no significant difference in the incidence of TB recurrence or other complications between the two groups (P > 0.05). All the patients with neurological dysfunction had improved after surgery. Conclusion Compared with anterior approach surgery, posterior approach surgery had equal effectiveness of debridement. The two kinds of surgery can effectively clear the lesions surrounding the spine and heal thoracic and lumbar TB.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Xiaobing Pu
- Department of Orthopedic Surgery, No.4 West China Teaching Hospital, Sichuan University, Chengdu, 610000, Sichuan, China
| | - Qiang Zhou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China.
| | - Xingzhou Huang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Chengmin Zhang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Lei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Zehua Zhang
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Tianyong Hou
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Fei Luo
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Fei Dai
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
| | - Jianzhong Xu
- Department of Orthopedics, Southwest Hospital, The Army (Third Military) Medical University, GaoTanYan 29, Chongqing, 400038, China
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Yin X, Yan L, Yang M, Liu S, He B, Liu Z, Hao D. Bilateral costotransverse and local continuous chemotherapy approach for debridement, fixation, and fusion of contiguous multisegmental thoracic spinal tuberculosis: A retrospective study. Medicine (Baltimore) 2018; 97:e12752. [PMID: 30313081 PMCID: PMC6203528 DOI: 10.1097/md.0000000000012752] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The study aims to evaluate the clinical efficacy of bilateral costotransverse debridement, transpedicular fixation, fusion, and local continuous chemotherapy in 20 patients of contiguous multisegmental thoracic spinal tuberculosis (CMTSTB). We analyzed 20 patients with contiguous thoracic spinal tuberculosis (TB) who underwent surgery via bilateral costotransverse debridement, fusion, posterior instrumentation, and postural drainage with local continuous chemotherapy. The clinical outcomes were evaluated in terms of kyphotic angle, bone fusion, neurologic status, erythrocyte sedimentation rate (ESR), and intraoperative and postoperative complications. All of the patients (8M/12F), averaged 45.8 ± 15.6 years old. The mean duration of postoperative follow-up was 30.7 ± 4.0 months. There was no recurrent TB infection. The values of ESR returned to normal levels at final follow-up. All patients got bony fusion within 8.1 ± 2.3 months after surgery. The average preoperative Cobb angle was 39.9° ± 8.6°, correcting to 9.8° ± 2.3° postoperatively and 10.8° ± 2.3° at the last follow-up. All patients with neurological deficit had dramatic improvement at the final follow-up. Our results showed that bilateral costotransverse surgery and local continuous chemotherapy are feasible and effective procedures in the treatment of CMTSTB. The approach can provide radical debridement, rebuild spinal stability, and cure TB.
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One-stage posterior surgical management of lumbosacral spinal tuberculosis with nonstructural autograft. Clin Neurol Neurosurg 2017; 153:67-72. [DOI: 10.1016/j.clineuro.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/23/2016] [Accepted: 12/25/2016] [Indexed: 11/15/2022]
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Patel H, Khoury H, Girgenti D, Welner S, Yu H. Burden of Surgical Site Infections Associated with Select Spine Operations and Involvement of Staphylococcus aureus. Surg Infect (Larchmt) 2016; 18:461-473. [PMID: 27901415 PMCID: PMC5466015 DOI: 10.1089/sur.2016.186] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Spine operations may be indicated for treatment of diseases including vertebral injuries, degenerative spinal conditions, disk disease, spinal misalignments, or malformations. Surgical site infection (SSI) is a clinically important complication of spine surgery. Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA), is a leading cause of post-spinal SSIs. METHODS PubMed and applicable infectious disease conference proceedings were searched to identify relevant published studies. Overall, 343 full-text publications were screened for epidemiologic, mortality, health care resource utilization, and cost data on SSIs associated with specified spine operations. RESULTS Surgical site infection rates were identified in 161 studies from North America, Europe, and Asia. Pooled average SSI and S. aureus SSI rates for spine surgery were 1.9% (median, 3.3%; range, 0.1%-22.6%) and 1.0% (median, 2.0%; range, 0.02%-10.0%). Pooled average contribution of S. aureus infections to spinal SSIs was 49.3% (median, 50.0%; range, 16.7%-100%). Pooled average proportion of S. aureus SSIs attributable to MRSA was 37.9% (median, 42.5%; range, 0%-100%). Instrumented spinal fusion had the highest pooled average SSI rate (3.8%), followed by spinal decompression (1.8%) and spinal fusion (1.6%). The SSI-related mortality rate among spine surgical patients ranged from 1.1%-2.3% (three studies). All studies comparing SSI and control cohorts reported longer hospital stays for patients with SSIs. Pooled average SSI-associated re-admission rate occurring within 30 d from discharge ranged from 20% to 100% (four studies). Pooled average SSI-related re-operation rate was 67.1% (median, 100%; range, 33.5%-100%). According to two studies reporting direct costs, spine surgical patients incur approximately double the health care costs when they develop an SSI. CONCLUSIONS Available published studies demonstrate a clinically important burden of SSIs related to spine operations and the substantial contribution of S. aureus (including MRSA). Preventive strategies aimed specifically at S. aureus SSIs could reduce health care costs and improve patient outcomes for spine operations.
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Affiliation(s)
| | | | | | | | - Holly Yu
- Pfizer Inc., Collegeville, Pennsylvania
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Liu JM, Chen XY, Zhou Y, Long XH, Chen WZ, Liu ZL, Huang SH, Yao HQ. Is nonstructural bone graft useful in surgical treatment of lumbar spinal tuberculosis?: A retrospective case-control study. Medicine (Baltimore) 2016; 95:e4677. [PMID: 27583894 PMCID: PMC5008578 DOI: 10.1097/md.0000000000004677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Surgical intervention is an important option for treating spinal tuberculosis. Previous studies have reported different surgical procedures and bone grafts for it. To our knowledge, few studies demonstrated the clinical results of using nonstructural autogenous bone graft in surgical treatment of spinal tuberculosis.The purpose of this study is to compare the clinical outcomes of surgical management lumbar spinal tuberculosis by one-stage posterior debridement with nonstructural autogenous bone grafting and instrumentation versus anterior debridement, strut bone grafting combined with posterior instrumentation.A total of 58 consecutive patients who underwent surgical treatment due to lumbar spinal tuberculosis from January 2011 to December 2013 were included. A total of 22 patients underwent one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation (group A), and 36 patients received anterior debridement, strut bone grafting combined with posterior instrumentation (group B). The operative duration, total blood loss, perioperative transfusion, length of hospital stay, hospitalization cost, and complications were recorded. The bony fusion of the graft was assessed by computed tomography scans. American Spinal Injury Association (ASIA) Impairment Scale was used to evaluate the neurological function of patients in the 2 groups.All the patients were followed up, with a mean follow-up duration of 21.6 ± 5.7 months in group A and 22.3 ± 6.2 months in group B (P = 0.47). The average operative duration was 257.5 ± 91.1 minutes in group A and 335.7 ± 91.0 minutes in group B (P = 0.002). The mean total blood loss was 769.6 ± 150.9 mL in group A and 1048.6 ± 556.9 mL in group B (P = 0.007). Also, significant differences were found between the 2 groups in perioperative transfusion volumes, length of hospital stay, and hospitalization cost (P < 0.05), which were less in group A compared with group B. Patients with ASIA grade C/D in the 2 groups were improved with 1 to 2 grades after the surgery with no statistical difference (P = 1.000). The perioperative complications rate was 9.1% (2/22) in group A and 13.9% (5/36) in group B (P = 0.897).Based on a retrospective study, the procedure of one-stage posterior debridement, nonstructural autogenous bone grafting, and instrumentation has a significant shorter operative duration, lower blood loss and perioperative transfusion, shorter hospital stay, and less hospitalization cost compared with the one of anterior debridement, strut bone grafting combined with posterior instrumentation for treating lumber spinal tuberculosis.
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Affiliation(s)
| | | | | | | | | | - Zhi-Li Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, PR China
- Correspondence: Zhi-Li Liu, Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, No. 17 Yongwaizheng Street, Donghu District, Nanchang 330006, PR China (e-mail: )
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Anterior versus posterior debridement fusion for single-level dorsal tuberculosis: the role of graft-type and level of fixation on determining the outcome. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:3884-3893. [PMID: 26988554 DOI: 10.1007/s00586-016-4516-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE This study compared the clinical, radiological and functional outcome of anterior versus posterior approaches for single-level dorsal tuberculosis with analysis of effect of graft type and fixation level on the outcome. METHODS Anterior group (AG): 43 cases (mean age: 49.5 years) fixed with Z-plate by anterior transthoracic-transpleural approach. Posterior group (PG): 49 cases (47.0 years) fixed with transpedicular-screws with unilateral facetectomy ± pediculectomy. Assessment was done using Frankel classification, blood-loss, operative-time, Kyphus-angle, correction loss, union and Oswestry disability index (ODI). RESULTS Both groups had similar operative-time, blood-loss, time to union, follow-up, and hospital-stay. Kyphus-angle improved from 36.6 ± 8.4° to 7.5 ± 2.3° (AG) and from 38.5 ± 5.9° to 11.1 ± 3.6° (PG) and this was significant. Postoperative Kyphus-angles were significantly better than preoperative ones in both groups. The correction percentage was 79.2 % (AG) and 69.9 % (PG) and this was significant. ODI was 3.4 ± 4.1 (AG) and 3.0 ± 4.2 % (PG) and this was insignificant. Correction loss was .8 ± 1.2° (AG) and 1.9 ± 2.2° (PG) and this was significant. Union was faster with iliac graft but with lower correction degree and higher correction loss than rib-strut graft. All patients achieved union. All but three patients achieved full neurological recovery. Superficial infection occurred in three cases (PG:2; AG:1) lung parenchymal injury in two case (AG), and DVT in one case (AG). CONCLUSIONS Both approaches give very good union and kyphosis correction rate that were maintained overtime. Anterior approach gives statistically better kyphosis correction and less correction-loss, but this is clinically insignificant. Besides, it is more risky and difficult. Strut-graft is essential in reconstruction and correction of kyphosis and vertebral height. LEVEL OF EVIDENCE III therapeutic.
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Zhou Y, Song Z, Luo J, Liu J, Huang Y, Meng Y, Wang W, Hao D. The efficacy of local continuous chemotherapy and postural drainage in combination with one-stage posterior surgery for the treatment of lumbar spinal tuberculosis. BMC Musculoskelet Disord 2016; 17:66. [PMID: 26862044 PMCID: PMC4746790 DOI: 10.1186/s12891-016-0921-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/03/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of this study was to compare the outcomes of one-stage posterior surgery involving debridement, bone grafting, and instrumentation with and without local continuous chemotherapy and postural drainage for the treatment of lumbar spinal tuberculosis. METHODS From January 2009 to January 2013, 109 patients with lumbar spinal tuberculosis were treated in our center using a posterior surgical approach. Patients underwent one-stage posterior debridement, bone grafting, and instrumentation, without (group A) and with (group B) local continuous chemotherapy and postural drainage. Clinical and radiographic results for the two groups were analyzed and compared. Clinical efficacy was evaluated based on surgery duration and blood loss. The Frankel scale was used to evaluate neurological function. A visual analog scale was used to assess low back pain. Bone graft fusion and instrumentation failure were monitored by radiography, and tuberculosis activity was monitored by erythrocyte sedimentation rate (ESR) and C-reactive protein testing. RESULTS Groups A and B contained 52 and 57 patients, respectively. Patients were followed for 18-36 (mean, 26.64 ± 4.2) months. All bone grafts ultimately fused, but the fusion rate was significantly more rapid in group B [6.4 ± 0.5 (range, 5-10) months] than in group A [8.9 ± 0.6 (range, 6-12) months; P < 0.05]. At 6 weeks postoperatively, ESR levels differed significantly between groups A and B (24.6 ± 1.5 vs. 16.3 ± 1.1 mm/h; P < 0.05). ESR levels normalized in both groups at 16 weeks. CONCLUSIONS Local continuous chemotherapy and postural drainage effectively eliminated infection foci caused by abscess remnants and accelerated interbody bone fusion in patients with lumbar spinal tuberculosis undergoing one-stage posterior surgery involving debridement, bone grafting, and instrumentation.
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Affiliation(s)
- Yongchun Zhou
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Zongrang Song
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Jing Luo
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Jijun Liu
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Yunfei Huang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Yibin Meng
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Wentao Wang
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
| | - Dingjun Hao
- Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, People's Republic of China.
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Abstract
A granulomatous infection of the spine is characterized by an infectious process within the spinal elements that results in the formation of a granuloma, an organized collection of transformed macrophages (ie, epithelioid cells), matrix, and other inflammatory cells. Causative organisms include various bacteria, fungi, or other parasites; however, the most frequently encountered causative organism is Mycobacterium tuberculosis (ie, Pott disease). The onset of these infections is often insidious, frequently leading to a delay in diagnosis. Left untreated, this disease process may lead to a compromise in the structural integrity of the spine and subsequent spinal deformity that may eventually result in compression of neural elements. Successful treatment of a granulomatous infection requires timely diagnosis, prompt medical management, and potential surgical intervention directed at the decompression of neural elements and the correction of spinal malalignment. Of granulomatous infections, tuberculous infections are the most thoroughly understood and serve as the standard to which other less commonly reported organisms are compared.
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Zhou T, Li C, Liu B, Tang X, Su Y, Xu Y. Analysis of 17 cases of posterior vertebral column resection in treating thoracolumbar spinal tuberculous angular kyphosis. J Orthop Surg Res 2015; 10:64. [PMID: 25962732 PMCID: PMC4447016 DOI: 10.1186/s13018-015-0195-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/21/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study aims to explore the efficacy and safety of posterior vertebral column resection (PVCR) in treating thoracolumbar spinal tuberculous angular kyphosis (TSTAK). METHODS From January 2008 to January 2012, 17 TSTAK patients were treated surgically, including five males and 12 females, with an average age of 23.6 years, among five cases who had the kyphotic apical vertebrae located at the thoracic vertebrae, ten cases were located at the thoracolumbar segment, and two cases were located at the lumbar vertebrae. The kyphotic Cobb angle was measured in the preoperative, postoperative, and final follow-up, respectively, and the nerve function ASIA classification was assessed. RESULTS The mean operative time was 364 min; the average intraoperative blood loss was 2,218 ml; and the average intraoperative blood transfusion was 1,863 ml. Among the five patients with the preoperative nerve function as grade D, four of them recovered to grade E. The preoperative average Cobb angle was 81.3° ± 12.8°, while the postoperative average Cobb average was 17.3° ± 3.6°; while it was significantly improved than the preoperative (P < 0.01), the average kyphosis correction rate was 68.7% ± 6.5%; the postoperative average follow-up was 18.7 months, with an average correction loss as 3.3°. CONCLUSION PVCR could be safely and effectively used in TSTAK.
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Affiliation(s)
- Tianhua Zhou
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
| | - Chuan Li
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
| | - Bin Liu
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
| | - Xun Tang
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
| | - Yongyue Su
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
| | - Yongqing Xu
- Department of Orthopedics, Kumming General Hospital of Chengdu Military Command, No.212 Daguan Road, Kunming, 650032, Yunnan, China.
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Xu Z, Wang X, Shen X, Luo C, Wu P, Zeng H. One-stage lumbopelvic fixation in the treatment of lumbosacral junction tuberculosis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2015; 24:1800-5. [PMID: 25757533 DOI: 10.1007/s00586-015-3863-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/30/2015] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE To investigate the clinical efficacy and feasibility of surgical treatment for lumbosacral junction tuberculosis by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage. METHODS A total of 15 cases with lumbosacral junction tuberculosis treated by one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage in our center from January 2005 to October 2011 were studied. Lumbosacral angle, visual analog scale (VAS), and neurological performance were assessed before and after surgery. RESULTS All patients were followed for 28-56 months post-operation (average, 40.7 ± 7.7 months). No severe complications occurred. Bone fusion occurred in all patients at a mean of 8.4 months (range 6-12 months) after surgery. The mean lumbosacral angle was significantly increased from the mean preoperative angle (20.9° ± 1.8°) both post-operatively (26.5° ± 1.6°) and at final follow-up (25.3° ± 1.4°) (both P < 0.05). All patients had significant post-operative improvement in neurological performance and VAS scores. CONCLUSIONS Our results suggest that one-stage posterior debridement, interbody fusion, lumbopelvic fixation, and postural drainage can be an effective and feasible treatment option for lumbosacral junction tuberculosis, offering fewer complications and a better quality of life.
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Affiliation(s)
- Zhengquan Xu
- Department of Spine Surgery, The Xiangya Hospital of Central-South University, Changsha, 410008, Hunan, China
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Ling T, Liu L, Yang X, Qiang Z, Hu X, An Y. Revision surgery for spinal tuberculosis with secondary deformity after treatment with debridement, instrumentation, and fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2014; 24:577-85. [PMID: 25542385 DOI: 10.1007/s00586-014-3742-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Revised: 12/19/2014] [Accepted: 12/21/2014] [Indexed: 02/05/2023]
Abstract
PURPOSE To discuss the cause and clinical efficacy of revision surgery for secondary deformity after treatment of spinal tuberculosis with debridement, instrumentation, and fusion. METHODS From September 2007 to March 2013, 15 patients with postoperative secondary deformity after treatment of spinal tuberculosis were enrolled. Constitutional symptoms, laboratory findings, and radiographic evidence were used to evaluate the secondary deformity conditions and diagnose the recurrence of spinal tuberculosis. All patients underwent revision surgery. The clinical and radiographic data from before and after previous surgery, before and after revision surgery, and after a minimum follow-up of 9 months were retrospectively reviewed. RESULTS Among 15 cases of secondary deformity, there were 8 recurrences of spinal tuberculosis. Anterior instrumentation was used in 9 patients, and posterior instrumentation in 6. Regarding previous surgery, the mean number of involved segments was 2 vertebral bodies; a mean of 4 vertebral bodies were fused; the mean preoperative scoliosis of 14.5° was corrected to 6.5° (52.08 % correction); the mean preoperative kyphosis of 56.4° was corrected to 28.9° (44.8 % correction). Before revision surgery, the mean kyphotic angle increased to 58.6° and the mean scoliosis angle increased to 19.6°. New deformity occurred at the primary levels in 11 patients and at the level adjacent to fused segments in 4. After revision surgery, a mean of 8 vertebral bodies were fused; at final follow-up, the mean kyphotic angle was corrected to 26.7° and the mean scoliosis angle was corrected to 2.4°. No neurologic complications were observed during or after revision surgery. No complications with instrumentation and recurrence of spinal tuberculosis were found at final follow-up. CONCLUSIONS Recurrence of spinal tuberculosis, incorrect choice of internal fixation strategy, unsuitable fused segments, and poor achievement of sagittal and coronal balance after surgery may lead to secondary deformity postoperatively. Good clinical outcomes were obtained by revision surgery to extend the fused segments, albeit with decreased spinal range of motion.
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Affiliation(s)
- Tingxian Ling
- Department of Orthopedics, West China Hospital, Sichuan University, 37 Guoxue Rd, Chengdu, 610041, China,
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One-stage posterior debridement and transpedicular screw fixation for treating monosegmental thoracic and lumbar spinal tuberculosis in adults. ScientificWorldJournal 2014; 2014:137106. [PMID: 24701134 PMCID: PMC3950547 DOI: 10.1155/2014/137106] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/14/2014] [Indexed: 11/18/2022] Open
Abstract
Spinal tuberculosis is still prevalent in some developing countries. The purpose of this study is to investigate the efficacy and safety of one-stage posterior debridement, autogenous bone grafting, and transpedicular screw fixation in treating monosegmental thoracic and lumbar tuberculosis in adults. 37 patients were retrospectively reviewed in this study. The data of images, operative time and blood loss volume, perioperative complications, time to achieve bony fusion, VAS score, and neurologic function preoperatively and postoperatively were collected. The mean follow-up period was 21.5 ± 3.5 months. The tuberculosis was cured after surgery in all patients, and no recurrence was observed. Bony fusion was achieved in all patients with a mean time of 5.6 ± 2.5 months. Neurological outcome did not change in one case with grade A, and increased by 1-3 grades in the other patients with nerve deficit. The average preoperative and postoperative VAS scores were 5.5 ± 2.23 and 1.5 ± 1.22, respectively; the difference was significant (P < 0.05). There were three perioperative complications (8.1%, 3/37) observed in this study. In conclusion, the procedure of one-stage posterior debridement, interbody fusion with autogenous bone grafting, and posterior fixation with pedicle screw is effective and safe for treating monosegmental thoracic and lumbar spinal tuberculosis in adults.
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