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Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis.

Cheng Z, Wang J, Zheng Q, Wu Y, Guo X - Medicine (Baltimore) (2015)

Bottom Line: However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months.These results showed satisfactory clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Orthopaedics, Union Hospital, Tongji Medical College, Hua-zhong University of Science and Technology, People's Republic of China (ZC, JW, QZ, YW, XG); and Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, People's Republic of China (ZC).

ABSTRACT
This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis. Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial. There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit. The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up. The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes.

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A 25-year-old female patient (a–h), preoperative X-ray (a, b) and MRI (c, d) shows T8, T9 vertebral body bone destruction with cyrtosis, compressed spinal dura mater, and paravertebral abscess. Postoperative 1 week, X-ray (e, f) show vertebral body height corrected with Cobb angle. Postoperative 1 year, X-ray (g, h) showed a good fixed position. MRI = magnetic resonance imaging
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Figure 1: A 25-year-old female patient (a–h), preoperative X-ray (a, b) and MRI (c, d) shows T8, T9 vertebral body bone destruction with cyrtosis, compressed spinal dura mater, and paravertebral abscess. Postoperative 1 week, X-ray (e, f) show vertebral body height corrected with Cobb angle. Postoperative 1 year, X-ray (g, h) showed a good fixed position. MRI = magnetic resonance imaging

Mentions: Erythrocyte sedimentation rate (ESR) gradually declined within 3 to 6 weeks postoperation. The ESR decreased to a normal level after an average of 2.8 months. Within the first week postoperatively, X-ray was used to review. The positions of bone graft or titanium mesh and their internal fixation were good in all the patients. During the follow-up, all the lesions were well repaired, and the bone graft or titanium mesh had a good bone fusion with the surrounding tissue, with a fusion rate of 100%. The fusion time for the single segment was 4 to 6 months, while that for multiple segments was 6 to 12 months. There was no obvious loosening or prolapsed internal fixation, nor were there broken or loose screws. The Cobb angle of cyrtosis at postoperative 1 week was 8.6° (5–13.8°). The average correct angle was 30.6°, and the correct rate was 78%. No obvious correction degree loss was detected during the follow-up period. A total of 16 patients with incomplete paraplegia had gradually recovered their sense, myodynamia and sphincter function in postoperative 1 week to 3 months by the last follow-up, and except for 1 patient whose ASIA score was at D level; nerve functions recovered in all the other patients (Table 1). Typical cases are shown in Figures 1 and 2.


Anterolateral radical debridement and interbody bone grafting combined with transpedicle fixation in the treatment of thoracolumbar spinal tuberculosis.

Cheng Z, Wang J, Zheng Q, Wu Y, Guo X - Medicine (Baltimore) (2015)

A 25-year-old female patient (a–h), preoperative X-ray (a, b) and MRI (c, d) shows T8, T9 vertebral body bone destruction with cyrtosis, compressed spinal dura mater, and paravertebral abscess. Postoperative 1 week, X-ray (e, f) show vertebral body height corrected with Cobb angle. Postoperative 1 year, X-ray (g, h) showed a good fixed position. MRI = magnetic resonance imaging
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554037&req=5

Figure 1: A 25-year-old female patient (a–h), preoperative X-ray (a, b) and MRI (c, d) shows T8, T9 vertebral body bone destruction with cyrtosis, compressed spinal dura mater, and paravertebral abscess. Postoperative 1 week, X-ray (e, f) show vertebral body height corrected with Cobb angle. Postoperative 1 year, X-ray (g, h) showed a good fixed position. MRI = magnetic resonance imaging
Mentions: Erythrocyte sedimentation rate (ESR) gradually declined within 3 to 6 weeks postoperation. The ESR decreased to a normal level after an average of 2.8 months. Within the first week postoperatively, X-ray was used to review. The positions of bone graft or titanium mesh and their internal fixation were good in all the patients. During the follow-up, all the lesions were well repaired, and the bone graft or titanium mesh had a good bone fusion with the surrounding tissue, with a fusion rate of 100%. The fusion time for the single segment was 4 to 6 months, while that for multiple segments was 6 to 12 months. There was no obvious loosening or prolapsed internal fixation, nor were there broken or loose screws. The Cobb angle of cyrtosis at postoperative 1 week was 8.6° (5–13.8°). The average correct angle was 30.6°, and the correct rate was 78%. No obvious correction degree loss was detected during the follow-up period. A total of 16 patients with incomplete paraplegia had gradually recovered their sense, myodynamia and sphincter function in postoperative 1 week to 3 months by the last follow-up, and except for 1 patient whose ASIA score was at D level; nerve functions recovered in all the other patients (Table 1). Typical cases are shown in Figures 1 and 2.

Bottom Line: However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine.The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months.These results showed satisfactory clinical outcomes.

View Article: PubMed Central - PubMed

Affiliation: From the Department of Orthopaedics, Union Hospital, Tongji Medical College, Hua-zhong University of Science and Technology, People's Republic of China (ZC, JW, QZ, YW, XG); and Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, People's Republic of China (ZC).

ABSTRACT
This retrospective cohort study was conducted to evaluate the clinical outcomes of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting with transpedicle fixation for the treatment of thoracolumbar tuberculosis. Spinal tuberculosis operation aims to remove the lesions and necrotic tissues, remove spinal cord compression, and reconstruct spinal stability. However, traditional operation methods cannot effectively correct cyrtosis or stabilize the spine. In addition, the patient needs to stay in bed for a long time and may have many complications. So far, the best surgical method and fixation method for spinal tuberculosis remain controversial. There were a total of 43 patients, 16 involving spinal cord injury, from January 2004 to January 2011. The patients were surgically treated for radical anterolateral debridement via posterolateral incision and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation. All the patients were followed up to determine the stages of intervertebral bone fusion and the corrections of spinal kyphosis with the restoration of neurological deficit. The erythrocyte sedimentation rate (ESR) of these patients decreased to normal levels for a mean of 2.8 months. The function of feeling, motion, and sphincter in 16 paraplegia cases gradually recovered after 1 week to 3 months postoperatively, and the American Spinal Injury Association scores significantly increased at the final follow-up. Intervertebral bone fusions were all achieved postoperatively. No internal fixation devices were loose, extracted, or broken. There was no correction degree loss during the follow-up. The method of radical anterolateral debridement and autogenous ilium with rib or titanium cage interbody autografting and single-stage transpedicle fixation was effective for the treatment of thoracolumbar tuberculosis, correcting kyphotic deformity, and reconstructing spinal stability, obtaining successful intervertebral bony fusion and promoting the recovery of paraplegia. These results showed satisfactory clinical outcomes.

Show MeSH
Related in: MedlinePlus