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Treatment effect, postoperative complications, and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery.

He QY, Xu JZ, Zhou Q, Luo F, Hou T, Zhang Z - J Orthop Surg Res (2015)

Bottom Line: This improvement was found in 3 cases of C, 6 cases of D, and 45 cases of E at a final follow-up postoperatively.Kyphosis Cobb angle improved from 62.2° ± 3.7° preoperatively to 37° ± 2.4° at final follow-up postoperatively.Both of these are significant improvements, and all bone grafts were fused.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China. 1349831917@qq.com.

ABSTRACT

Objective: Fifty-four juvenile cases under 18 years of age with thoracic and lumbar spinal tuberculosis underwent focus debridement, deformity correction, bone graft fusion, and internal fixation. The treatment effects, complications, and reasons were analyzed retrospectively.

Material and method: There were 54 juvenile cases under 18 years of age with thoracolumbar spinal tuberculosis. The average age was 9.2 years old, and the sample comprised 38 males and 16 females. The disease types included 28 thoracic cases, 17 thoracolumbar cases, and 9 lumbar cases. Nerve function was evaluated with the Frankel classification. Thirty-six cases were performed with focus debridement and deformity correction and were supported with allograft or autograft in mesh and fixed with pedicle screws from a posterior approach. Eight cases underwent a combined anterior and posterior surgical approach. Nine cases underwent osteotomy and deformity correction, and one case received focus debridement. The treatment effects, complications, and bone fusions were tracked for an average of 52 months.

Results: According to the Frankel classification, paralysis was improved from 3 cases of B, 8 cases of C, 18 cases of D, and 25 cases of E preoperatively. This improvement was found in 3 cases of C, 6 cases of D, and 45 cases of E at a final follow-up postoperatively. No nerve dysfunction was aggravated. VAS was improved from 7.8 ± 1.7 preoperatively to 3.2 ± 2.1 at final follow-up postoperatively. ODI was improved from 77.5 ± 17.3 preoperatively to 28.4 ± 15.9 at final follow-up postoperatively. Kyphosis Cobb angle improved from 62.2° ± 3.7° preoperatively to 37° ± 2.4° at final follow-up postoperatively. Both of these are significant improvements, and all bone grafts were fused. Complications related to the operation occurred in 31.5% (17/54) of cases. Six cases suffered postoperative aggravated kyphosis deformity, eight cases suffered proximal kyphosis deformity, one case suffered pedicle penetration, one case suffered failure of internal devices, and one case suffered recurrence of tuberculosis.

Conclusion: As long as the treatment plan is fully prepared, the surgical option can achieve a satisfactory curative effect in treating juvenile spinal tuberculosis despite some complications.

No MeSH data available.


Related in: MedlinePlus

Female, 4 years, T11 and T12, L1 TB with paravertebral cold abscess formation. Preoperative X-ray AP and lateral view, kyphotic Cobb angle of 45°; preoperative two-dimensional sagittal CT, T12 and L1 vertebral severe destruction; preoperative MR, spinal cord was compressed at the T12, L1 level; Intraoperative images, anterior TB lesion debridement, titanium mesh implantation with autologous bone graft + posterior pedicle osteotomy and pedicle screw fixation; postoperative X-ray AP and lateral view, pedicle screws fixation at T10, T11, T12, L2, L3, autogenous bone grafting and fusion range limited between T11, T12 and L2 with kyphotic Cobb angle 8°; postoperative X-ray AP and lateral view 24 months postoperatively, T10, L3 pedicle screws were removed, keeping T11, T12, L2 vertebral pedicle screw fixation; successfully bone fusion range limited between T11, T12, and L2 with kyphotic Cobb angle 8°
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Fig2: Female, 4 years, T11 and T12, L1 TB with paravertebral cold abscess formation. Preoperative X-ray AP and lateral view, kyphotic Cobb angle of 45°; preoperative two-dimensional sagittal CT, T12 and L1 vertebral severe destruction; preoperative MR, spinal cord was compressed at the T12, L1 level; Intraoperative images, anterior TB lesion debridement, titanium mesh implantation with autologous bone graft + posterior pedicle osteotomy and pedicle screw fixation; postoperative X-ray AP and lateral view, pedicle screws fixation at T10, T11, T12, L2, L3, autogenous bone grafting and fusion range limited between T11, T12 and L2 with kyphotic Cobb angle 8°; postoperative X-ray AP and lateral view 24 months postoperatively, T10, L3 pedicle screws were removed, keeping T11, T12, L2 vertebral pedicle screw fixation; successfully bone fusion range limited between T11, T12, and L2 with kyphotic Cobb angle 8°

Mentions: Through increasing the number of pedicle screws, increasing anchor fixed point, and fusing more segments, the goal of increasing fixation and orthopedic force could be achieved, thus reducing the possibility of kyphosis deformity, but fusing too many segments will affect the children’s growth and development. In order to solve this dilemma, more segments could be fixed but only tuberculosis-damaged segments were fused. After bone fusion was achieved (6–12 months), the internal fixation in non-fused segments could be removed; this strategy not only increased the intensity of internal fixation and limited the range of bone graft fusion but kept the mobility of the spinal segments of outside lesions as well (Fig. 2).Fig 2


Treatment effect, postoperative complications, and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery.

He QY, Xu JZ, Zhou Q, Luo F, Hou T, Zhang Z - J Orthop Surg Res (2015)

Female, 4 years, T11 and T12, L1 TB with paravertebral cold abscess formation. Preoperative X-ray AP and lateral view, kyphotic Cobb angle of 45°; preoperative two-dimensional sagittal CT, T12 and L1 vertebral severe destruction; preoperative MR, spinal cord was compressed at the T12, L1 level; Intraoperative images, anterior TB lesion debridement, titanium mesh implantation with autologous bone graft + posterior pedicle osteotomy and pedicle screw fixation; postoperative X-ray AP and lateral view, pedicle screws fixation at T10, T11, T12, L2, L3, autogenous bone grafting and fusion range limited between T11, T12 and L2 with kyphotic Cobb angle 8°; postoperative X-ray AP and lateral view 24 months postoperatively, T10, L3 pedicle screws were removed, keeping T11, T12, L2 vertebral pedicle screw fixation; successfully bone fusion range limited between T11, T12, and L2 with kyphotic Cobb angle 8°
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4590253&req=5

Fig2: Female, 4 years, T11 and T12, L1 TB with paravertebral cold abscess formation. Preoperative X-ray AP and lateral view, kyphotic Cobb angle of 45°; preoperative two-dimensional sagittal CT, T12 and L1 vertebral severe destruction; preoperative MR, spinal cord was compressed at the T12, L1 level; Intraoperative images, anterior TB lesion debridement, titanium mesh implantation with autologous bone graft + posterior pedicle osteotomy and pedicle screw fixation; postoperative X-ray AP and lateral view, pedicle screws fixation at T10, T11, T12, L2, L3, autogenous bone grafting and fusion range limited between T11, T12 and L2 with kyphotic Cobb angle 8°; postoperative X-ray AP and lateral view 24 months postoperatively, T10, L3 pedicle screws were removed, keeping T11, T12, L2 vertebral pedicle screw fixation; successfully bone fusion range limited between T11, T12, and L2 with kyphotic Cobb angle 8°
Mentions: Through increasing the number of pedicle screws, increasing anchor fixed point, and fusing more segments, the goal of increasing fixation and orthopedic force could be achieved, thus reducing the possibility of kyphosis deformity, but fusing too many segments will affect the children’s growth and development. In order to solve this dilemma, more segments could be fixed but only tuberculosis-damaged segments were fused. After bone fusion was achieved (6–12 months), the internal fixation in non-fused segments could be removed; this strategy not only increased the intensity of internal fixation and limited the range of bone graft fusion but kept the mobility of the spinal segments of outside lesions as well (Fig. 2).Fig 2

Bottom Line: This improvement was found in 3 cases of C, 6 cases of D, and 45 cases of E at a final follow-up postoperatively.Kyphosis Cobb angle improved from 62.2° ± 3.7° preoperatively to 37° ± 2.4° at final follow-up postoperatively.Both of these are significant improvements, and all bone grafts were fused.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopedics, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street Shapingba District, Chongqing, 400038, China. 1349831917@qq.com.

ABSTRACT

Objective: Fifty-four juvenile cases under 18 years of age with thoracic and lumbar spinal tuberculosis underwent focus debridement, deformity correction, bone graft fusion, and internal fixation. The treatment effects, complications, and reasons were analyzed retrospectively.

Material and method: There were 54 juvenile cases under 18 years of age with thoracolumbar spinal tuberculosis. The average age was 9.2 years old, and the sample comprised 38 males and 16 females. The disease types included 28 thoracic cases, 17 thoracolumbar cases, and 9 lumbar cases. Nerve function was evaluated with the Frankel classification. Thirty-six cases were performed with focus debridement and deformity correction and were supported with allograft or autograft in mesh and fixed with pedicle screws from a posterior approach. Eight cases underwent a combined anterior and posterior surgical approach. Nine cases underwent osteotomy and deformity correction, and one case received focus debridement. The treatment effects, complications, and bone fusions were tracked for an average of 52 months.

Results: According to the Frankel classification, paralysis was improved from 3 cases of B, 8 cases of C, 18 cases of D, and 25 cases of E preoperatively. This improvement was found in 3 cases of C, 6 cases of D, and 45 cases of E at a final follow-up postoperatively. No nerve dysfunction was aggravated. VAS was improved from 7.8 ± 1.7 preoperatively to 3.2 ± 2.1 at final follow-up postoperatively. ODI was improved from 77.5 ± 17.3 preoperatively to 28.4 ± 15.9 at final follow-up postoperatively. Kyphosis Cobb angle improved from 62.2° ± 3.7° preoperatively to 37° ± 2.4° at final follow-up postoperatively. Both of these are significant improvements, and all bone grafts were fused. Complications related to the operation occurred in 31.5% (17/54) of cases. Six cases suffered postoperative aggravated kyphosis deformity, eight cases suffered proximal kyphosis deformity, one case suffered pedicle penetration, one case suffered failure of internal devices, and one case suffered recurrence of tuberculosis.

Conclusion: As long as the treatment plan is fully prepared, the surgical option can achieve a satisfactory curative effect in treating juvenile spinal tuberculosis despite some complications.

No MeSH data available.


Related in: MedlinePlus