One-stage anterior debridement,bone grafting and posterior instrumentation vs. single posterior debridement,bone grafting,and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis

Purpose

The aim of this study was to compare single posterior debridement, interbody fusion and instrumentation with one-stage anterior debridement, interbody fusion and posterior instrumentation for treating thoracic and lumbar spinal tuberculosis.

Method

From January 2006 to January 2010, we enrolled 115 spinal tuberculosis patients with obvious surgical indications. Overall, 55 patients had vertebral body destruction, accompanied by a flow injection abscess or a unilateral abscess volume greater than 500 ml. The patients underwent one-staged anterior debridement, bone grafting and posterior instrumentation (group A) or single posterior debridement, bone grafting and instrumentation (group B). Clinical and radiographic results for the two groups were analyzed and compared.

Results

Patients were followed 12–36 months (mean 21.3 months), Fusion occurred at 4–12 months (mean 7.8 months). There were significant differences between groups regarding the post-operative kyphosis angle, angle correction and angle correction rate, especially if pathology is present in thoracolumbar and lumbar regions. Operative complications affected five patients in group A, and one patient in group B. A unilateral psoas abscess was observed in three patients 12 months postoperatively. In one of them, interbody fusion did not occur, and there was fixation loosening and interbody absorption. All of them were cured by an anterior operation.

Conclusion

Anterior debridement and bone grafting with posterior instrumentation may not be the best choice for treating patients with spinal tuberculosis. Single posterior debridement/bone grafting/instrumentation for single-segment of thoracic or lumbar spine tuberculosis produced good clinical results, except in patients who had a psoas abscess.     

Thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage

Purpose

Retrospective analysis of the clinical efficacy and feasibility of patients with thoracolumbar spinal tuberculosis with psoas abscesses treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.

Method

A total of 18 patients with thoracolumbar tuberculosis (TB), between February 2007 and February 2011, underwent one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage. And the clinical efficacy was evaluated based on surgery duration time, the blood loss, the postural drainage of time, neurological status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, the fate of bone graft fusion, kyphosis angle, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at certain time.

Results

The average follow-up period was 34 months (range 18–48 months). 18 patients suffered from seriously neurological deficits pre-operatively, of which 16 patients returned to normal at final follow-up. The surgery duration time was 197 ± 37.9 min, and the blood loss was 815 ± 348.5 ml. The postural drainage of time was 7.2 ± 2.7 days. The psoas abscesses disappeared in all cases, within the time range of 6–9 months (mean 7.4 ± 1.2 months). All patients of the grafted bones were thoroughly fused, with a fusion time ranging from 4 to 12 months (mean 7.8 months). Kyphosis angle was 44.32 ± 7.26° on average pre-operative and returned to 11.72 ± 2.85° at 6 weeks after operation; kyphosis angle was 13.10 ± 2.39° at final follow-up. The values of ESR and CRP were significant declined at 6 weeks post-operative, and returned to normal levels at final follow-up.

Conclusion

With standardized anti-TB chemotherapy, thoracolumbar spinal tuberculosis with psoas abscesses could be effectively treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, posterior instrumentation, and postural drainage.     

One-stage posterior debridement, transforaminal lumbar interbody fusion and instrumentation in treatment of lumbar spinal tuberculosis: a retrospective case series

Purpose

The purpose of this study is to compare the clinical outcomes of surgical management by one-stage posterior debridement, transforaminal lumbar interbody fusion (TLIF) and instrumentation and combined posterior and anterior approaches for lumbar spinal tuberculosis, and determine the clinical effectiveness of the posterior only surgical treatment for lumbar spinal TB at the same time.

Methods

Thirty-seven patients who suffered lumbar tuberculosis were treated by two different surgical procedures in our center from May 2004 to June 2012. All the cases were divided into two groups: 19 cases in Group A underwent one-stage posterior debridement, TLIF and instrumentation, and 18 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single-stage procedure. The operation time, blood loss, lumbar kyphotic angle, recovery of neurological function and fusion time were, respectively, compared between Group A and Group B.

Results

The average follow-up period for Group A was 46.6 ± 16.7 months, and for Group B, 47.5 ± 15.0 months. It was obvious that the average operative duration and blood loss of Group A was less than those of Group B. Lumbar tuberculosis was completely cured and the grafted bones were fused in 10 months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. The average pretreatment ESR was 60.7 ± 22.5 mm/h, which became normal (9.0 ± 2.8 mm/h) within 3 months in all patients.

Conclusions

Surgical management by one-stage posterior debridement, TLIF and instrumentation for lumbar tuberculosis is feasible and effective. This approach obtained better clinical outcomes than combined posterior and anterior surgeries.     

Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged

Purpose

To evaluate the clinical study efficacy and feasibility of 17 aged patients with lumbo-sacral tuberculosis treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation.

Methods

17 aged patients who suffered from lumbo-sacral tuberculosis were admitted into our hospital between March 2003 and October 2010. All of them were treated by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation. Then the clinical efficacy with statistical analysis was evaluated based on the materials on the lumbo-sacral angle, neurological status that was recorded by Frankel grade system, and erythrocyte sedimentation rate (ESR), which were collected at certain time.

Results

The average follow-up period was 47.5?±?17.1?months (17?C71?months), In the 17 cases, no postoperative complications related to instrumentation occurred and neurologic function was improved in various degrees. The mean preoperative lumbo-sacral angle was 20.5°?±?1.7° (range 18.0°?C23.0°). The lumbo-sacral angle became 29.1°?±?1.5° (range 26.4°?C31.0°) postoperatively. The average pretreatment ESR was 57.4?±?16.8?mm/h (33?C95?mm/h), which got normal (9.2?±?3.1?mm/h) within 3?months in all patients. All patients got bony fusion within 6?C8?months after surgery.

Conclusions

One-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation can be an effective treatment method for the treatment of lumbo-sacral tuberculosis in the aged patients.     

Surgical treatment of thoracic spinal tuberculosis with adjacent segments lesion via one-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion, a clinical study

Purpose

To investigate the clinical efficacy and feasibility of one-stage surgical treatment for thoracic spinal tuberculosis with adjacent segments lesion by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach.

Materials and methods

Twenty-one patients (thirteen males, eight females) with thoracic tuberculosis whose lesions were confined to two adjacent segments were studied retrospectively. All patients were treated with one-stage surgical treatment by internal fixation, transpedicular debridement, and combined interbody and posterior fusion via a posterior-only approach. The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. Thoracic Cobb angle was used to assess thoracic kyphosis. Operating time, blood loss, complications, neurological function, deformity correction and interbody fusion were investigated.

Results

Average mean operating time was 231.4 ± 31.9 min, and evaluated blood loss during operation was 880.2 ± 112.7 ml. All patients were followed up for 22–41 months postoperatively (average 29.8 ± 5.4 months). All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 9°–25° postoperatively (average 16.7° ± 4.4°), and at final follow-up were 10°–27°(average 17.7° ± 4.4°). No severe complications or spinal cord injury occurred. The erythrocyte sedimentation rate recovered to normal within 3 months postoperatively in all patients. All patients got bony fusion within 6–9 months after surgery.

Conclusions

One-stage transpedicular debridement, posterior instrumentation and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method for thoracic spinal tuberculosis.     

One-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis

Purpose

Retrospective analysis of the clinical study efficacy and feasibility of one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation in treating lumbosacral spinal tuberculosis.

Method

A total of 21 patients with lumbosacral tuberculosis (TB) collected from January 2004 to January 2010, underwent one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation. In addition, the clinical efficacy was evaluated based on the data on the lumbo-sacral angle, neuro-logical status that was recorded by American Spinal Injury Association (ASIA) Impairment Scale, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), which were collected at specific time points.

Results

All cases were followed up for 16–36 months (average 24.9 ± 6.44 months). 18 patients suffered from evident neurological deficits preoperatively, of which 16 patients returned to normal at the final follow-up. Two patients with neurological dysfunction aggravated postoperative, experienced significant partial neurological recovery. With an effective and standard anti-TB chemotherapy treated, the values of ESR and CRP returned to normal levels 3-month later postoperative and maintained till the final follow-up. Preoperative lumbosacral angle was 20.89 ± 2.32° and returned 29.62 ± 1.41° postoperative. During long-term follow-up, there was only 1–3° lumbosacral angle loss. There was a significant difference between preoperative and postoperative lumbosacral angles.

Conclusion

With effective and standard anti-TB chemotherapy, one-stage posterior transforaminal lumbar debridement, 360° interbody fusion, and posterior instrumentation for lumbosacral tuberculosis can effectively relieve pain symptoms, improve neurological function, and reconstruct the spinal stability.     

One-stage posterior focus debridement,interbody graft using titanium mesh cages,posterior instrumentation and fusion in the surgical treatment of lumbo-sacral spinal tuberculosis in the aged

Purpose

Aged patients represent a high risk group for acquiring spinal tuberculosis, and it still remains a leading cause of kyphosis and paraplegia in developing nations. Aged patients often combined with cardiovascular and respiratory disease and single lung ventilation via anterior approach surgery could result in more post-operative complications. We aimed to analyze the efficacy and feasibility of surgical management of aged patients with lumbo-sacral spine tuberculosis using one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion.

Methods

From March 2009 and July 2012, 17 aged patients with lumbo-sacral spinal tuberculosis were treated with one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion. There were eight male and nine female with a mean age of 63.3 years (range: 60–71 years). The mean follow-up was 46.5 months (range 38–70 months). Patients were evaluated before and after surgery in terms of ESR, neurological status, visual analog scale (VAS), and lumbosacral angle.

Results

Spinal tuberculosis was completely cured and the grafted bones were fused in all 17 patients. There were no recurrent tuberculous infections. ESR became normal within three months in all patients. The ASIA neurological classification and VAS scores improved in all cases. The average preoperative lumbosacral angle was 20.6° (range 18.1°–22.5°) and became 29.4° (range 27.1°–32.5°) at final follow-up.

Conclusions

Our results showed that one-stage posterior focus debridement, interbody graft using titanium mesh cages, posterior instrumentation, and fusion was an effective treatment for aged patients with lumbo-sacral spinal tuberculosis. It is characterized with minimum surgical trauma, good pain relief, good neurological recovery, and good reconstruction of the spinal stability.

     

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via posterior-only approach

Purpose

To investigate the clinical efficacy and feasibility of one-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach.

Methods

Fourteen patients (eight males, six females) with upper thoracic tuberculosis whose lesions were confined to two adjacent segments were admitted to our hospital. Their ages ranged from 23 to 72 years (average, 50 years). The American Spinal Injury Association (ASIA) impairment scale was used to assess neurological function. ASIA classification showed that preoperatively, one patient was grade A, two patients were grade B, eight patients were grade C, and three patients were grade D. All patients were treated with one-stage surgical treatment by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach. Patients were evaluated preoperatively and postoperatively by measurement of thoracic kyphotic angles using Cobb angle evaluation, determination of erythrocyte sedimentation rate (ESR), evaluation of ASIA impairment scale, and radiological examination.

Results

Operation time ranged from 70 to 135 min, (average, 110 min). Intraoperative blood loss ranged from 200 to 950 mL (average, 450 mL). All patients were followed up for 22 to 48 months postoperatively (average, 31.5 months). No sinus tract formation, cerebrospinal meningitis, or recurrence of tuberculosis occurred. All patients had significant postoperative improvement in ASIA classification scores. The thoracic kyphotic angles were significantly decreased to 12°–26° postoperatively, and at final follow-up were 13°–28°. The ESR recovered to normal within 6 months postoperatively in all patients. Bone fusion was achieved within 3–8 months (average, 5.5 months).

Conclusions

One-stage surgical treatment for upper thoracic spinal tuberculosis by internal fixation, debridement, and combined interbody and posterior fusion via a posterior-only approach can be an effective and feasible treatment method.     

Surgical management for thoracic spinal tuberculosis in the elderly: posterior only versus combined posterior and anterior approaches

Purpose

To compare the clinical outcomes of surgical management by posterior only and combined posterior and anterior approaches for thoracic spinal tuberculosis in the elderly.

Materials and methods

This was a retrospective cohort study. Thirty-six cases of thoracic spinal tuberculosis treated by two different surgical procedures in our center from January 2004 to June 2009 were studied. All the cases were divided into two groups: 20 cases in Group A underwent single-stage posterior debridement, transforaminal fusion and instrumentation, and 16 cases in Group B underwent posterior instrumentation, anterior debridement and bone graft in a single- or two-stage procedure. The operation time, blood loss, correction rate, recovery of neurological function, fusion time and complications were, respectively, compared between Group A and Group B.

Results

All patients were followed up for an average of 35.1?±?5.8?months (range 26?C45?months). It was obviously that the average operative duration, blood loss, hospitalization and complication rate of Group A was less than those of Group B. Spinal tuberculosis was completely cured and the grafted bones were fused in 10?months in all patients. There was no persistence or recurrence of infection and no differences in the radiological results in both groups. The kyphosis was significantly corrected after surgical management. However, loss of correction also occurred in both groups.

Conclusion

Our study showed that the posterior approach only procedure obtained better clinical outcomes than combined posterior and anterior surgeries. It might be a better surgical treatment for thoracic spinal tuberculosis in aged patients with poor health status, especially for cases in early phase of bone destruction and/or mild and moderate kyphosis.     

Thoracoscopic interbody fusion with percutaneous posterior stabilization for thoracic and thoracolumbar injuries

Background context

Traumatic thoracolumbar discoligamentous injuries and partial burst fractures are commonly managed through posterior-only stabilization. Many cases present later with failure of posterior implant and progressive kyphotic deformities that necessitates major surgeries. Anterior interbody fusion saves the patients unnecessary long-segment fixation and provides a stable definitive solution for the injured segment.

Purpose

The purpose of this study is to assess the clinical and radiographic outcomes of combined minimal invasive short-segment posterior percutaneous instrumentation and anterior thoracoscopic-assisted fusion in thoracolumbar partial burst fractures or discoligamentous injuries.

Study design

Prospective observational study.

Patient sample

Thirty patients with acute thoracic or thoracolumbar injuries operated upon between December 2007 and January 2009.

Outcome measures

Oswestry Disability Index (ODI), clinical and neurological examination for clinical assessment. Plain X-ray for radiological evaluation.

Methods

Preoperative evaluation included clinical and neurological examination, plain X-rays, computed tomography (CT), and magnetic resonance imaging (MRI). Posterior short-segment percutaneous stabilization plus anterior thoracoscopically assisted fusion in prone position were done. The minimum follow-up period was 2 years (range 24–48 months).

Results

The mean age was 44 years. The commonest affected segment was between T10 and L1 (22 patients, 73 %). The mean total operative time was 103 min. The mean operative blood loss was 444 ml. Interbody fusion cage was used in 28 patients while iliac graft in two cases. Fusion rate at the final follow-up was 97 % (29 patients); one patient did not show definitive fusion although he was clinically satisfied. The mean final follow-up ODI was 12 %. The mean preoperative kyphosis angle was 22° improved to 6.5° postoperatively and was 7.5° at final follow-up. There were no major intraoperative or postoperative complications.

Conclusion

Combined anterior thoracoscopic fusion and short-segment posterior percutaneous instrumentation showed good clinical and radiographic outcomes in cases of thoracolumbar injuries through limiting the instrumented levels and preventing progress of posttraumatic kyphosis.     

Surgical management for multilevel noncontiguous thoracic spinal tuberculosis by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF)

Purpose

Multilevel noncontiguous thoracic spinal tuberculosis has rarely been reported in the literature. We present a retrospective clinical study of 14 patients with multilevel noncontiguous thoracic spinal tuberculosis treated by single-stage posterior transforaminal thoracic debridement, limited decompression, interbody fusion, and posterior instrumentation (modified TTIF) and determine the clinical effectiveness of such surgical treatment for MNTST.

Methods

Fourteen patients with multilevel noncontiguous thoracic spinal tuberculosis were treated with modified TTIF. The mean follow-up was 27.36?±?10.46?months (range 13–42?months). The kyphotic angle ranged from ?2° to 47° before operation, with an average of 19.21°?±?12.63°. The erythrocyte sedimentation rate (ESR) of patients upon admission ranged from 30 to 62?mm/h before operation, with an average of 46.43?±?10.77?mm/h. The Frankel Grade was used to evaluate the neurological deficits.

Results

The average ESR got normal (8.14?±?5.89?mm/h) within 3?months in all patients. The average kyphotic angle decreased to 8.07°?±?6.91° postoperatively. Mean deformity angle was measured as 8.79°?±?7.29° at the last visit. Solid fusion was achieved in all cases. Neurologic status of the 12 patients with preoperative neurologic deficit was 6 with grade D recovered to normal; 2 with grade B, both of them to grade D; 4 with grade C, 2 to grade D, 1 to grade E, and 1 still in grade C.

Conclusions

Modified TTIF can be an effective treatment method of multilevel noncontiguous thoracic spinal tuberculosis.     

Clinical evaluation of the stability of single-segment short pedicle screw fixation for the reconstruction of lumbar and sacral tuberculosis lesions

Introduction

The routine surgical approach to posterior reconstruction in spinal tuberculosis is short- or long-segment fixation and/or fusion. This method sacrifices movement at more than one vertebral level, limits normal movement of the spinal column, and leads to degeneration of the small joints of the adjacent levels. Surgical techniques that reduce the number of fixed vertebral levels and maximize the retention of movement of the spinal column are of current interest in the treatment of spinal tuberculosis.

Materials and methods

A total of 106 patients with lumbosacral tuberculosis were randomly divided into two groups: a single-segment fixation group and a short-segment fixation group. After posterior correction and internal fixation, all patients underwent anterior radical debridement and interbody fusion with bone grafting.

Results

The mean postoperative follow-up period was 58.09?±?17.01?months. The average bone graft healing time was 4.35?±?1.04?months in the single-segment group and 4.47?±?1.10?months in the short-segment group. In the single-segment group, correction of the Cobb angle was 14.47?±?3.76° and the loss rate was 7.22?%, and in the short-segment group, correction of the Cobb angle was 16.20?±?2.70° and the loss rate was 6.37?% (P?P?Conclusions Single-segment pedicle screw fixation and correction surgery can fix and fuse the diseased segment in lumbar and sacral tuberculosis, retain normal movement in the adjacent spinal column, and promote functional recovery of the spinal column postoperatively. It was be regarded as a cost-effective means of treatment with lumbar and sacral tuberculosis.     

Posterior instrumentation, anterior column reconstruction with single posterior approach for treatment of pyogenic osteomyelitis of thoracic and lumbar spine

Purpose

Surgical treatment of thoracolumbar osteomyelitis consists of radical debridement, reconstruction of anterior column either with or without posterior stabilization. The objective of present study is to evaluate a case series of patients with osteomyelitis of thoracic and lumbar spine treated by single, posterior approach with posterior instrumentation and anterior column reconstruction.

Methods

Seventeen patients underwent clinical and radiological evaluation pre and postoperatively with latest follow-up at 19 months (8–56 months) after surgery. Parameters assessed were site of infection, causative organism, angle of deformity, blood loss, duration of surgery, ICU stay, deformity correction, time to solid bony fusion, ambulatory status, neurologic status (ASIA impairment scale), and functional outcome (Kirkaldy-Willis criteria).

Results

Mean operating time was 207 min and average blood loss 1,150 ml. Patients spent 2 (1–4) days in ICU and were able to walk unaided 1.6 (1–2) days after surgery. Infection receded in all 17 patients postoperatively. Solid bony fusion occurred in 15 out of 17 patients (88 %) on average 6.3 months after surgery. Functional outcome was assessed as excellent or good in 82 % of cases. Average deformity correction was 8 (1–18) degrees, with loss of correction of 4 (0–19) degrees at final follow-up.

Conclusions

Single, posterior approach addressing both columns poses safe alternative in treatment of pyogenic vertebral osteomyelitis of thoracic and lumbar spine. It proved to be less invasive resulting in faster postoperative recovery.     

Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting

Purpose

The aim of this prospective study is the analysis of the clinical and radiological outcomes of active thoraco-lumbar spinal tuberculosis treated with isolated posterior instrumentation without any posterior bone grafting or anterior inter-body bone grafting or anterior instrumentation.

Methods

The study was a prospective follow-up of 25 patients with active thoraco-lumbar spinal tuberculosis who underwent posterior spinal instrumentation with pedicle screws and rods. These patients had posterior stabilization of the involved segment of the spine without anterior or posterior bone grafting. The mean duration of follow-up was 3.3 years and the minimum duration of follow-up was 2 years.

Results

The mean kyphotic angle improved from 32.4° pre-operatively to 7.2° in the early follow-up period. Following a minor loss of correction during follow-up, the mean kyphotic angle settled at 11.5° at the time of final follow-up. Inter-body bony fusion was noticed at the final follow-up in all patients despite the absence of anterior bone grafting or cages.

Conclusion

Posterior instrumented stabilization followed by chemotherapy seems to be adequate for obtaining satisfactory healing of the lesions. Anterior inter-body bony arthrodesis occurs despite the absence of anterior bone grafts or cages. Careful patient selection is critical for successful outcome with this technique.     

Posterior only versus combined posterior and anterior approaches in surgical management of lumbosacral tuberculosis with paraspinal abscess in adults

Purpose

To compare single-stage posterior transforaminal lumbar interbody fusion, debridement, posterior instrumentation, and postural drainage (posterior-only surgery) with a combined posterior-anterior surgical approach for treatment of adults with lumbosacral spinal tuberculosis (STB) with paraspinal abscess and to determine the clinical feasibility and effectiveness of posterior-only surgical treatment.

Methods

Thirty-nine patients with lumbosacral STB and paraspinal abscess were treated with one of two surgical procedures in our center from September 2003 to December 2012. Nineteen patients were treated with posterior-only surgery (Group A) and 20 were treated with combined posterior–anterior surgery (Group B). Surgery duration, intraoperative blood loss, length of hospitalization, bony fusion rates, complication rates, neurological status, lumbosacral angle correction, and Kirkaldy-Willis functional outcomes of the two groups were compared.

Results

The average follow-up period was 39.1 ± 12.0 months for Group A and 40.7 ± 12.4 months for Group B. Under the Frankel classification, all patients improved with treatment. STB was completely cured and grafted bones were fused within 5–11 months in all patients. There were no persistent or recurrent infections or obvious differences in radiological results between the groups. The lumbosacral angle was significantly corrected after surgical management, but loss of correction was seen in both groups. The average operative duration, blood loss, length of hospital stay, and postoperative complication rate of Group A were lower than those of Group B.

Conclusions

Posterior-only surgery is feasible and effective, resulting in better clinical outcomes than combined posterior–anterior surgeries, especially in surgical time, blood loss, hospital stay, and complications.     

One-stage posterior debridement and fusion combined with irrigation and drainage for the treatment of postoperative lumbar spondylodiscitis

Objective

The aim of this study was to evaluate the clinical outcomes of one-stage posterior debridement, interbody fusion, and instrumentation, combined with irrigation and drainage, for treating lumbar spondylodiscitis.

The role of costotransverse radical debridement,fusion and postural drainage in the surgical treatment of multisegmental thoracic spinal tuberculosis: a minimum 5-year follow-up

Purpose

We present a retrospective study of patients with multilevel contiguous tuberculous spondylitis of thoracic region that underwent single-stage posterolateral debridement and fusion and following posterior instrumentation.

Methods

From June 2000 to March 2009, 870 consecutive spinal tubercular patients including 36 patients who were diagnosed and treated as multilevel contiguous thoracic spinal tuberculosis in our institution. Apart from five patients being treated conservatively, the 31 cases received surgery by single-stage posterolateral debridement, fusion, following posterior instrumentation and postural drainage. The patients were evaluated based on the Frankel scoring system, kyphotic Cobb angle, and visual analog scale (VAS) pain score.

Results

The mean duration of postoperative follow-up was 79.2 ± 9.9 months (range 62–98 months). Neither mortalities nor any major complications were found. Solid bony fusion was achieved in all patients. No patients with neurological deficit deteriorated postoperatively. According to Frankel scoring system, 7 cases were rated as Grade D, 24 cases as Grade E at last follow-up. The average preoperative Cobb’s angle was 32° (range 21°–39°). The average early postoperative Cobb’s angle was 23° (range 15°–32°). The mean latest postoperative Cobb’s angle was 26° (range 20°–32°), with a small loss of correction at last follow-up. Pre-op VAS was 8.8 ± 0.7 (range 7–10) and final follow-up was 1.8 ± 1.1. There was a significant difference of VAS between preoperation and the final follow-up.

Conclusions

One-stage surgical treatment for multilevel contiguous spinal tuberculosis by posterolateral debridement, fusion, posterior instrumentation can be an effective and feasible treatment method.

     

A retrospective study of 113 consecutive cases of surgically treated spondylodiscitis patients. A single-center experience

Background

Recommendations for the operative treatment of spondylodiscitis are still a controversial issue.

Methods

A retrospective review identified 113 consecutive patients who underwent surgical debridement and instrumentation for spondylodiscitis between 2006 and 2010 at our department.

Results

The mean age at presentation was 65 years; 78 patients were male (69 %). Distribution of the inflammation was lumbar in 68 (60 %), thoracic in 19 (17 %) and cervical in 20 (18 %) cases. Six patients (5 %) had two concomitant non-contiguous spondylodiscitis foci in different segments of the spine. Epidural abscess was found in 33 patients (29 %). One hundred four patients (92 %) had pain. Neurological deficit was found in 40 patients (35 %). In the thoracic and lumbar cases, dorsal instrumentation alone was considered sufficient in 26 cases; additional interbody fusion from the posterior was performed in 44 cases. A 360° instrumentation was performed in 22 cases. In the cervical cases, only ventral spondylodesis and plating were performed in eight cases, only dorsal instrumentation in five and 360° instrumentation in seven. Postoperative intravenous antibiotics were administered for 14.4?±?9.3 (mean ± SD) days followed by 3.2?±?0.8 (mean ± SD) months of oral antibiosis. Complete healing of the inflammation was achieved in 111 (98 %) cases. Two patients died because of septic shock, both with fulminant endocarditis. Pain resolved in all cases. Neurological deficits were completely resolved in 20 patients, and 14 patients had a partial recovery.

Conclusion

The results of our retrospective study show that surgical treatment of spondylodiscitis with a staged surgical approach (if needed) and a short 1-2-week period of intravenous antibiotics followed by 3 months of oral antibiotics is appropriate for most patients in whom conservative treatment has failed or is not advisable. Furthermore, surgical treatment of newly diagnosed spondylodiscitis might be recommended as an initial treatment option in many cases. Thereby the choice of fusion material (autologous bone, titanium, PEEK) seems less important.     

The role of surgical timing in the treatment of thoracic and lumbar spinal tuberculosis

Purpose

To determine the outcome and safety of surgical treatment of thoracic and lumbar spinal tuberculosis in patients without obvious clinical and laboratory improvement after preoperative short-time chemotherapy.

Methods

Data of 86 patients with single-level thoracic and lumbar tuberculosis, treated by one-stage posterior instrumentation combined with anterior radical debridement and fusion, were studied retrospectively. Patients were divided into two groups based on the results of erythrocyte sedimentation rate (ESR) after preoperative 2-week chemotherapy. Surgical outcome and prognosis were compared between the two groups.

Results

After antituberculous chemotherapy for 2 weeks, the ESR did not decrease or even increase in 57 patients (group A), but decreased in 29 patients (group B). However, the ESR decreased gradually after surgery and returned to a normal level at the final follow-up in both groups. Between group A and B, no significant difference was observed in pain improvement (6.3 ± 1.4, 6.4 ± 1.4, respectively, P = 0.805). The corrected angle was 12.4° ± 5.9°, 13.8° ± 6.4°, respectively, for group A and group B (P = 0.305).

Conclusions

It is safe and effective to carry out the surgery just after a short-time antituberculous chemotherapy. And it is the postoperative drugs, not the preoperative drugs, that play an important role in reinforcing the surgical outcome.     

Posterior transpedicular debridement, decompression and instrumentation for thoracic tuberculosis in patients over the age of 60

Aim

Our aim was to evaluate the feasibility and efficiency of the application of posterior transpedicular debridement with instrumentation and fusion to the treatment of over 60-year-old patients with thoracic tuberculosis.

Methods

Fifteen over 60-year-old patients with thoracic tuberculosis treated by posterior transpedicular debridement with instrumentation and fusion between August 2006 and November 2010, seven males and eight females in this study were reviewed, retrospectively. Their age ranged from 61 to 75 (mean age 63.4). The follow-up period ranged from 12 to 51?months (mean 30?months). The patients were evaluated based on vertebral body loss, kyphotic angle, fusion status of affected segment, visual analog scale (VAS) pain score, and Frankel’s classification.

Results

A solid fusion was achieved in all 15 cases. No postoperative complications, chronic infection, sinus formation or significant loss of deformity correction was noted in these patients. Moreover, VAS score was reduced and Frankel’s grade was recovered in all patients and there was no recurrence of the tuberculous infection.

Conclusions

Posterior transpedicular debridement with instrumentation and fusion is a feasible and effective procedure in the treatment for thoracic tuberculosis in patients over the age of 60.