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One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases.

Zeng H, Zhang P, Shen X, Luo C, Xu Z, Zhang Y, Liu Z, Wang X - BMC Musculoskelet Disord (2015)

Bottom Line: Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up.Neurological condition in all patients improved after surgery.Careful patient selection is critical to the successful outcome with this technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China. 1985008521@qq.com.

ABSTRACT

Background: There are quite a few controversies on the surgical management of single-segment thoracic spinal tuberculosis with neurological deficits (STSTND). In this study, the clinical efficacy and feasibility of one-stage posterior-only transpedicular debridement, interbody fusion, and posterior instrumentation for treating STSTND in adults were retrospectively evaluated.

Methods: Thirty-four cases with STSTND underwent one-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation at the same institution from January 2003 to January 2013. Follow-up time was 34.4 ± 10.2 months (range, 18-48 months), and kyphosis angle was 34.1 ± 12.3°. The American Spinal Injury Association (ASIA) classification of spinal cord injury was employed to evaluate neurological deficits, while visual analogue scale (VAS) was employed to assess the degree of pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the activity of tuberculosis (TB).

Results: All 34 patients with spinal tuberculosis (ST) were completely cured, and there was no recurrence of TB. Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up. Solid fusion was achieved and pain was relieved in all cases. Neurological condition in all patients improved after surgery.

Conclusions: One-stage posterior-only transpedicular debridement, interbody fusion, and posterior fixation followed by chemotherapy seems to be adequate for obtaining satisfactory healing of single-segment thoracic spinal tuberculosis with neurological deficits. Careful patient selection is critical to the successful outcome with this technique.

No MeSH data available.


Related in: MedlinePlus

A 52-year-old female with T5/6 lesions was performed by posterior-only approach. a-d The pre-operative imaging data showed T5/6 vertebral bodies’ destructions with mild kyphosis deformity and spinal cord severely compressed. The postoperative anterior-posterior (e) and lateral X-ray (f) indicated that the kyphosis got obviously improved by posterior long-segment fixation. Sagittal and coronal CT-scan (g, h) showed satisfied allograft fusion without relapse of Pott’s disease at the 9 months of post-operation
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Fig3: A 52-year-old female with T5/6 lesions was performed by posterior-only approach. a-d The pre-operative imaging data showed T5/6 vertebral bodies’ destructions with mild kyphosis deformity and spinal cord severely compressed. The postoperative anterior-posterior (e) and lateral X-ray (f) indicated that the kyphosis got obviously improved by posterior long-segment fixation. Sagittal and coronal CT-scan (g, h) showed satisfied allograft fusion without relapse of Pott’s disease at the 9 months of post-operation

Mentions: Kyphosis angle was 34.1 ± 12.3°, preoperatively; which significantly decreased to 8.2 ± 1.8°, postoperatively (P < 0.05). Kyphosis angle was 9.7 ± 2.0° at final follow-up with a loss of correction of only 1.5 ± 0.6°. This continued to significantly improve compared to preoperative measurements (P < 0.05). Intervertebral bone graft and intertransverse fusions were performed in all patients. Lateral X-ray or CT was used to assess the fusion and formation of the bone bridge. All patients achieved bone fusion within 4.5 ± 3.2 months after surgery, which was confirmed by two different surgeons based on the modified criteria of Lee et al. [12] for radiological fusion (Figs. 3 and 4). Average pretreatment for ESR and CRP was 40.2 ± 6.3 mm/h and 22.4 ± 5.7 mg/L, respectively; which returned to normal levels during the final follow-up in all patients. There was a statistical difference in ESR and CRP between the preoperative period and during final follow-up (P < 0.05). (Table 1)Fig. 3


One-stage posterior-only approach in surgical treatment of single-segment thoracic spinal tuberculosis with neurological deficits in adults: a retrospective study of 34 cases.

Zeng H, Zhang P, Shen X, Luo C, Xu Z, Zhang Y, Liu Z, Wang X - BMC Musculoskelet Disord (2015)

A 52-year-old female with T5/6 lesions was performed by posterior-only approach. a-d The pre-operative imaging data showed T5/6 vertebral bodies’ destructions with mild kyphosis deformity and spinal cord severely compressed. The postoperative anterior-posterior (e) and lateral X-ray (f) indicated that the kyphosis got obviously improved by posterior long-segment fixation. Sagittal and coronal CT-scan (g, h) showed satisfied allograft fusion without relapse of Pott’s disease at the 9 months of post-operation
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526180&req=5

Fig3: A 52-year-old female with T5/6 lesions was performed by posterior-only approach. a-d The pre-operative imaging data showed T5/6 vertebral bodies’ destructions with mild kyphosis deformity and spinal cord severely compressed. The postoperative anterior-posterior (e) and lateral X-ray (f) indicated that the kyphosis got obviously improved by posterior long-segment fixation. Sagittal and coronal CT-scan (g, h) showed satisfied allograft fusion without relapse of Pott’s disease at the 9 months of post-operation
Mentions: Kyphosis angle was 34.1 ± 12.3°, preoperatively; which significantly decreased to 8.2 ± 1.8°, postoperatively (P < 0.05). Kyphosis angle was 9.7 ± 2.0° at final follow-up with a loss of correction of only 1.5 ± 0.6°. This continued to significantly improve compared to preoperative measurements (P < 0.05). Intervertebral bone graft and intertransverse fusions were performed in all patients. Lateral X-ray or CT was used to assess the fusion and formation of the bone bridge. All patients achieved bone fusion within 4.5 ± 3.2 months after surgery, which was confirmed by two different surgeons based on the modified criteria of Lee et al. [12] for radiological fusion (Figs. 3 and 4). Average pretreatment for ESR and CRP was 40.2 ± 6.3 mm/h and 22.4 ± 5.7 mg/L, respectively; which returned to normal levels during the final follow-up in all patients. There was a statistical difference in ESR and CRP between the preoperative period and during final follow-up (P < 0.05). (Table 1)Fig. 3

Bottom Line: Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up.Neurological condition in all patients improved after surgery.Careful patient selection is critical to the successful outcome with this technique.

View Article: PubMed Central - PubMed

Affiliation: Department of Spine Surgery, the Xiangya Hospital of Central South University, 87# Xiangya Road, Changsha, Hunan, 410008, People's Republic of China. 1985008521@qq.com.

ABSTRACT

Background: There are quite a few controversies on the surgical management of single-segment thoracic spinal tuberculosis with neurological deficits (STSTND). In this study, the clinical efficacy and feasibility of one-stage posterior-only transpedicular debridement, interbody fusion, and posterior instrumentation for treating STSTND in adults were retrospectively evaluated.

Methods: Thirty-four cases with STSTND underwent one-stage posterior-only transpedicular debridement, interbody fusion and posterior instrumentation at the same institution from January 2003 to January 2013. Follow-up time was 34.4 ± 10.2 months (range, 18-48 months), and kyphosis angle was 34.1 ± 12.3°. The American Spinal Injury Association (ASIA) classification of spinal cord injury was employed to evaluate neurological deficits, while visual analogue scale (VAS) was employed to assess the degree of pain. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to evaluate the activity of tuberculosis (TB).

Results: All 34 patients with spinal tuberculosis (ST) were completely cured, and there was no recurrence of TB. Postoperative kyphosis angle was 8.2 ± 1.8°, and there was no significant loss of correction during the final follow-up. Solid fusion was achieved and pain was relieved in all cases. Neurological condition in all patients improved after surgery.

Conclusions: One-stage posterior-only transpedicular debridement, interbody fusion, and posterior fixation followed by chemotherapy seems to be adequate for obtaining satisfactory healing of single-segment thoracic spinal tuberculosis with neurological deficits. Careful patient selection is critical to the successful outcome with this technique.

No MeSH data available.


Related in: MedlinePlus