Efficacy analysis of the single-stage posterior debridement and titanium cage reconstruction combined with screw rod fixation for the treatment of thoracic and lumbar tuberculosis
Tang Hao*, Jiang Xiaowei, Wang Chen, Liu Guangwang, Han Meng, Liu Guangpu, Ma Chao.
*Department of Orthopaedics, Medical College of Southeast University, Nanjing 210009, China
Abstract：Objective To evaluate the efficacy of single-stage posterior debridement and Titanium cage reconstruction combined with screw rod in the treatment of thoracic and lumber spinal tuberculosis.Methods Thirty-one patients with thoracic and lumber spinal tuberculosis, from March 2011 to March 2013, including 14 males and 17 females, with an average of 41.5 years, had underwent single-stage posterior debridement and Titanium cage reconstruction combined with screw rod fixation surgery at Department of Spinal Surgery of Central Hospital of Xuzhou. Eight patients were in thoracic vertebrae(T6-10), 7 patients were in thoracolumbar vertebrae(T11-L2) and the left 16 patients were in lumbar vertebrae(L3-5). Paraspinal abscess was found in 6 patients. Eighteen patients had neurological deficit. Twenty-three patients were found with the mean Cobb′s angle (31.5°±7.3°) (range 11°-52°). The routine antituberculous therapy was continued regularly after the operation. The efficacy of the operation was evaluated by observing the VAS score, the function of the spinal cord and the improvement of the spinal deformity after the operation.Results Surgery was successfully performed in 31 patients, the mean time of operation was (172.4±36.6) min(range, 135-270 min), mean blood loss was (521.3±179.2) mL(range, 400-1 100 mL). No dural, nerve and large blood vessels were injured during the operation and no cerebrospinal fluid leakage after operation. All patients were followed up, the mean time was 13 months(range, 6-21 months). The mean VSA score was (1.3±1.1) points at tenth days after operation, which was significantly decreased compared with preoperative(6.6±1.4) points (t=16.253, P<0.01). All patients after 6 months to review the X-ray showed interbody bone block outline was not clear, callus formation. Twenty-five 25 patients were followed up for more than 10 months and achieved interbody bony fusion. In 18 patients with neurological deficit, the ASIA was significantly improved at last follow-up, among them, 2 patients were restored to grade C, 3 patients were restored to grade D, 13 patients were restored to grade E. There were significant differences between the preoperative and postoperative for patients (Z=3.378, P<0.05). The kyphosis Cobb′s angle was 10.7°± 4.6°(range 5.7°-19.5°) at the fifth day after operation. At last follow-up, the kyphosis Cobb′s angle was 12.1°±3.7°(range, 6.9°-21.6°). Compared with the preoperative, the difference was significantly lower, and the difference was statistically significant(t=15.306, 12.776, all P values<0.05). erythrocyte sedimentation rate returned to normal 4 months later. According to standard for treatment of tuberculosis in 12 months after operation, 17 patients were cured, and the remaining 6 patients were treated with continuing anti tuberculosis treatment. Conclusions For the patients with thoracic and lumber spinal tuberculosis, if they do not merge with lumbar muscle abscess and lesions were relatively limited, single-stage posterior debridement and Titanium cage reconstruction combined with screw rod can efficiently remove tuberculosis and remain spinal stabilization.
汤浩,姜效韦,王宸,刘光旺,韩猛,刘光普,马超. 一期后路病灶清除钛笼重建联合钉棒系统治疗胸腰椎结核疗效分析[J]. 中华解剖与临床杂志, 2016, 21(5): 432-436.
Tang Hao, Jiang Xiaowei, Wang Chen, Liu Guangwang, Han Meng, Liu Guangpu, Ma Chao.. Efficacy analysis of the single-stage posterior debridement and titanium cage reconstruction combined with screw rod fixation for the treatment of thoracic and lumbar tuberculosis. Chinese Journal of Anatomy and Clinics, 2016, 21(5): 432-436.
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2016, Vol. 21 
