-
[show abstract]
[hide abstract]
ABSTRACT: Objective: To investigate surgical methods and outcomes in the treatment of spinal tuberculosis (TB) in adults. Subjects and Methods: One hundred and eighty-one patients (average age 39 years) without multiple-level noncontiguous spinal TB were followed up for 22-72 months. The patients were divided into four groups according to surgical procedure on the basis of the position and extension of the foci: group A (74 cases): anterior radical debridement and strut grafting with instrumentation; group B (83 cases): posterior instrumentation and bone grafting with anterior radical debridement and strut grafting in a single- or two-stage procedure; group C (10 cases): extrapleural anterolateral decompression and strut grafting with posterior instrumentation in thoracic or thoracolumbar spine, and group D (27 cases): single-stage transforaminal decompression and posterior instrumentation and fusion. Results: There was a significant decrease (p < 0.05) in mean preoperative (81%) Oswestry's Disability Index. Except for 24 patients with lumbosacral TB who were only instrumented posteriorly, kyphosis degrees were corrected by a mean of 11.5° in the anterior instrumentation group and 12.6° in the posterior instrumentation group (p < 0.01). The correction loss was 6.8° in the anterior instrumentation group and 6.1° in the posterior instrumentation group at the last follow-up (p < 0.01). Conclusion: The four surgical procedures obtained good results for correction and maintenance of the correction, clearance of the foci, decompression of the spinal cord and pain relief in the treatment of spinal TB in adults, providing that the operative indication is accurately identified. However, the posterior approach was superior to anterior instrumentation for correcting deformity and maintaining the correction.
Medical Principles and Practice 02/2013; · 0.89 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To compare the outcomes of anterior verus posterior instrumentation under different surgical procedures in the surgical management of thoracolumbar spinal tuberculosis (TB).
Between January 2004 and December 2009, 241 adult patients with thoracolumbar spinal TB underwent radical debridement and strut grafting plus anterior or posterior instrumentation in single-stage or two-stages. The mean age was 39 years (range: 16 - 67). The mean follow-up period for 189 patients was 37 months (range: 22 - 72). Among them, 157 cases underwent > 3 weeks of chemotherapeutic regimen of isoniazid, rifampin, pyrazinamide and ethamburol and the remaining 32 were operated for neurological impairment after 6-18 h with the same chemotherapeutic regimen. Except for 8 patients with skip lesions undergoing hybrid anterioposterior instrumentation, anterior instrumentation was utilized in 74 patients (Group A) and posterior instrumentation in 107 patients (Group B).
In both groups, local symptoms of all patients were relieved significantly 1-3 weeks postoperatively. And 10/14 cases (71%) in Group A and 14/19 cases (74%) in Group B with neurological deficits had excellent or good clinical outcomes (P > 0.05). The levels of erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.4 mm/h preoperatively to normal at 8-12 weeks postoperatively. Kyphosis degrees were corrected by a mean of 11.5° in Group A and 12.6° in Group B (P < 0.01). The correction loss was 6.8° in Group A and 6.1° in Group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8% respectively at the final follow-up (P > 0.05). Severe complications did not occur.
Either anterior or posterior instrumentation can obtain good results in correction and maintenance of deformity, clearance of foci, decompression of spinal cord and pain relief in the treatment of thoracolumbar spinal TB as long as the surgical indications are properly selected. Posterior instrumentation may be superior to anterior instrumentation in the correction and maintenance of deformity.
Zhonghua yi xue za zhi 05/2012; 92(19):1325-9.
-
[show abstract]
[hide abstract]
ABSTRACT: There are few articles in the literature comparing outcomes between anterior and posterior instrumentation in the management of thoracic and lumbar spinal tuberculosis (TB).
Between January 2004 and December 2009, 217 adult patients, average age 39 (range 16-67) years with thoracic and lumbar spinal TB were treated by anterior radical debridement and fusion plus instrumentation, anterior radical debridement with fusion and posterior fusion with instrumentation, posterolateral debridement and fusion plus posterior instrumentation or transpedicular debridement and posterior fusion with instrumentation in a single- or two-stage procedure. We followed up 165 patients for 22-72 (mean 37) months. Of these, 138 underwent more than three weeks chemotherapy with isoniazid, rifampin, pyrazinamide and ethambutol, and the remaining 27 underwent operation for neurological impairment within six to 18 hours of the same chemotherapy regimen. In no case did relapse occur. Apart from eight patients with skip lesions treated by hybrid anterior and posterior instrumentation, anterior instrumentation was used in 74 patients (group A) and 83 patients (group B) were fixed posteriorly.
In both groups, local symptoms were relieved significantly one to three weeks postoperatively; ten of 14 patients (71%) in group A and 14 of 19 (74%) in group B with neurological deficit had excellent or good clinical results (P > 0.05). Erythrocyte sedimentation rates (ESR) returned from 43.6 mm/h and 42.7 mm/h, respectively, preoperatively to normal levels eight to 12 weeks postoperatively. Kyphosis degree was corrected by a mean of 11.5° in group A and 12.6° in group B, respectively (P < 0.01). Correction loss was 6.8° in group A and 6.1° in group B at the last follow-up (P < 0.01). Fusion rates of the grafting bone were 92.5% and 91.8%, respectively, at final follow-up (P > 0.05). Severe complications did not occur.
These results suggest that both anterior and posterior instrumentation attain good results for correction of the deformity and maintaining correction, foci clearance, spinal-cord decompression and pain relief in the treatment of thoracic and lumbar spinal TB providing that the operative indication is accurately identified. However, the posterior approach may be superior to anterior instrumentation to correct deformity and maintain that correction.
International Orthopaedics 02/2012; 36(2):299-305. · 2.03 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To investigate perioperative features and results of surgical treatment of spinal tuberculosis in aged.
Review the clinical data of 36 aged with spinal tuberculosis from May 1998 to June 2005 retrospectively. The average age was 70.2 years. The sites of infection included 3 cervical, 9 thoracic, 13 thoracolumbar and 11 lumbar. 28 patients suffered 1 or more complications at least and among of them, there were 18 patients have cerebral or heart vascular disease, 16 patients have diabetes mellitus. Before operation, all patients consulted with internal stuff for the proper treatment of concomitant disease. The surgical procedures include: CT guided percutaneous catheter drainage in 3 patients, anterior debridement and bony grafting with anterior instrumentation fixation in 12 patients, anterior debridement and bony grafting with posterior fixation in 5 patients, posterolateral costotransversectomy debridement and interbody fusion with posterior fixation in 7 patients, posterior debridement and posterior fixation in 9 patients. The mean followed-up period was 3 years and 10 months (from 1.5 to 6 years).
One died at two week after the operation. Tuberculous infection was controlled in other patients and no recurrence. Two patients died because of myocardial infarction and cerebral hemorrhage respectively at 1.5 and 2.5 years after operation. Bone fusion was achieved in 31 patients. The deformity was partial corrected at the final follow-up. Among 20 cases with neurologic deficit, 11 cases were completely recovered, 5 cases were partly improved.
If the associated disorders and postoperative complications are properly handled, aged patients can endure surgical treatment for spinal tuberculosis. Instrumentation fixation provides adequate stability and promote recovery.
Zhonghua wai ke za zhi [Chinese journal of surgery] 10/2007; 45(18):1233-6.
