Clinical efficacy of one-stage anterior debridement, bone graft and reconstruction titanium plate internal fixation in treating lumbosacral spinal tuberculosis
Xia Xi, Tang Shaofeng, Cao Zhiwu, Wang Hui, Yao Nyuzhao, Wang Wenjun
Department of Spinal Surgery, the First Affiliated Hospital of University of South China, Hengyang 421001, China
Abstract：Objective To evaluate clinical outcomes following one-stage anterior radical debridement, interbody fusion, and reconstruction titanium plate internal fixation for the treatment of lumbosacral spinal tuberculosis. Methods The clinical data of 30 patients (17 males and 13 females, aged range from 27 to 65 years, mean 37.5 years) with tuberculosis of the lumbosacral segments(including L5-S1)who were treated with anterior radical debridement, autologous iliac bone graft,and internal fixation with reconstruction titanium plate at Department of Spinal Surgery of the First Affiliated Hospital of University of South China from August 2011 to August 2014 were retrospectively reviewed. All patients routinely received antitubercular drugs for 2 to 3 weeks before operation. Operation was performed when the general condition improved. All patients were systematically and routinely treated with antituberculous drug for 12-18 months after operation. The preoperative, 3 months after operation, last follow up erythrocyte sedimentation rate(ESR), C reactive protein(CRP), visual analog scale (VAS) , as well as Oswestry disability index (ODI) were analyzed. Results Thirty patients were followed up for 12-36 months, mean 18 months. At last follow-up, no lower limb radiation pain and tuberculosis recurrence were found in all cases. The VAS scores were significantly decreased from 7.8±1.7 at preoperation to 1.7±0.6 at 3 months after operation, and 1.5±0.5 at last follow-up(all P values<0.01). The ODI were significantly decreased from 71.20%±18.24% at preoperation to 13.41%±5.82% at 3 months after operation and 10.22%±4.28% at last follow-up (all P values<0.01). The ESR were significantly decreased from (37.8±15.2) mm/1 h at preoperation to (11.6±3.7)mm/1 h at 3 months after operation and (10.3± 3.3)mm/1 h at last follow-up(all P values<0.01), and the CRP were reduced from (26.4±8.2) mg/L at preoperation to (6.8±2.9) mg/L at 3 months after operation and (6.4±2.1) mg/L at last follow-up(all P values<0.01), but no significant differences were found between VAS, ODI, ESR, CRP at 3 months after operation and last follow-up (all P values>0.05). Conclusions Based on systemic and routine antituberculosis treatment, the surgical treatment of lumbosacral spinal tuberculosis with one-stage anterior debridement, bone graft and reconstruction titanium plate internal fixation have a direct and safe access to lesions of lumbosacral tuberculosis, and eradicate tuberculosis kitchen, reconstruct spinal stability and achieve good clinical outcome.
夏曦,唐绍锋,曹志武,王辉,姚女兆,王文军. 一期前路病灶清除植骨重建钛板内固定术治疗腰骶段脊柱结核[J]. 中华解剖与临床杂志, 2016, 21(3): 231-235.
Xia Xi, Tang Shaofeng, Cao Zhiwu, Wang Hui, Yao Nyuzhao, Wang Wenjun. Clinical efficacy of one-stage anterior debridement, bone graft and reconstruction titanium plate internal fixation in treating lumbosacral spinal tuberculosis. Chinese Journal of Anatomy and Clinics, 2016, 21(3): 231-235.
Macnab I. Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients[J]. J Bone Joint Surg Am, 1971, 53(5): 891-903
Bezer M, Kucukdurmaz F, Aydin N, et al. Tuberculous spondylitis of the lumbosacral region: long-term follow-up of patients treated by chemotherapy, transpedicular drainage, posterior instrumentation, and fusion[J]. J Spinal Disord Tech, 2005, 18(5): 425-429
Li JH, Zhang ZH, Shi T, et al. Surgical treatment of lumbosacral tuberculosis by one-stage debridement and anterior instrumentation with allograft through an extraperitoneal anterior approach[J]. J Orthop Surg Res, 2015, 10: 62. DOI:10.1186/s13018-015-0204-x
[16]
Fantini GA, Pappou IP, Girardi FP, et al. Major vascular injury during anterior lumbar spinal surgery: incidence, risk factors, and management[J]. Spine (Phila Pa 1976), 2007, 32(24): 2751-2758. DOI:10.1097/BRS.0b013e31815a996e
[17]
Lindley EM, Mcbeth ZL, Henry SE, et al. Retrograde ejaculation after anterior lumbar spine surgery[J]. Spine (Phila Pa 1976), 2012, 37(20): 1785-1789. DOI:10.1097/BRS.0b013e31825752bc
[18]
Fischer CR, Braaksma B, Peters A, et al. Outcomes and complications of the midline anterior approach 3 years after lumbar spine surgery[J]. Adv Orthop, 2014, 2014: 142604. DOI:10.1155/2014/142604
Cagli S, Crawford NR, Sonntag VK, et al. Biomechanics of grade I degenerative lumbar spondylolisthesis. Part 2: treatment with threaded interbody cages/dowels and pedicle screws[J]. J Neurosurg, 2001, 94(1 Suppl): 51-60
[21]
van Schaik J, van Baalen JM, Visser MJ, et al. Nerve-preserving aortoiliac Reconstruction surgery: anatomical study and surgical approach[J]. J Vasc Surg, 2001, 33(5): 983-989.
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