Download PDF
CC BY-NC-ND 4.0 · Z Orthop Unfall 2022; 160(06): 679-685
DOI: 10.1055/a-1851-5509
Original Article

Isolated Posterior Instrumentation for Selected Cases of Thoracic and Lumbar Spinal Tuberculosis without Radical Debridement

Selected Cases of Thoracic and Lumbar Spinal TuberculosisIsolierte posteriore Instrumentierung bei ausgewählten Fällen von thorakaler und lumbaler Spinaltuberkulose ohne radikales DebridementAusgewählte Fälle von thorakaler und lumbaler Spinaltuberkulose
Shuming Ye 
1   Department of Orthopaedics Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, China (Ringgold ID: RIN533251)
,
Jian Sun
2   Department of Orthopedics Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, China (Ringgold ID: RIN533251)
,
Juehua Jing
2   Department of Orthopedics Surgery, Second Affiliated Hospital of Anhui Medical University, Hefei, China (Ringgold ID: RIN533251)
› Author AffiliationsSupported by: Hefei Municipal Natural Science Foundation 2021010
Supported by: Natural Science Foundation of Anhui Province Universities KJ2020A0182
Supported by: clinical research cultivation project of the second affiliated hospital of Anhui Medical University 2020LCYB07
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background The purpose of this study was to evaluate the clinical outcomes of thoracic and lumbar spinal tuberculosis treated with isolated posterior instrumentation without radical debridement.

Methods This study retrospectively analyzed 73 patients with thoracic and lumbar spinal tuberculosis who were treated using isolated posterior instrumentation without radical debridement in our hospital between January 2012 to December 2019. The patient group was composed of 42 men and 31 women with a mean age of 67.3 ± 8.6 years. The tuberculosis spine instability score (TSIS) was used to evaluate spine stability. All patients received chemotherapy for 18 months after surgery. The time of surgery, blood loss, visual analogue score (VAS), kyphosis angle, Oswestry disability index (ODI), erythrocyte sedimentation rate (ESR), Frankel grading, SF-36 scores, and local recurrence and complications were analyzed to evaluate the efficacy of isolated posterior instrumentation surgery in the treatment of thoracic and lumbar spinal tuberculosis.

Results All patients were followed up for 12 to 24 months (mean 14 ± 3.2 months). The mean surgical time was 1.2 ± 1.4 h (range, 1.2–1.6 h), and mean blood loss was 107 ± 18 mL. The postoperative symptoms were obviously relieved. The VAS, kyphosis angle, DI, and ESR decreased, respectively, from 8.24 ± 1.32, 19.82 ± 3.42, 46.25 ± 3.62, and 49.64 ± 17.61 to 1.12 ± 0.21, 7.14 ± 0.81, 20.17 ± 5.11, and 0.35 ± 1.13 at final follow-up. In comparison to preoperative values, SF-36 scores were significantly improved at final follow-up and the differences were statistically significant (p < 0.05). All patients achieved neurological recovery at the final follow-up. There were no recurrences or complications in any of the patients.

Conclusion Isolated posterior instrumentation without radical debridement is a suitable minor surgical trauma that offers a remarkable advantage of effective pain relief, improvement in neurological function and performance status, and no local recurrence for selected patients with thoracic and lumbar spinal tuberculosis.

Zusammenfassung

Hintergrund Ziel dieser Studie war es, die klinischen Ergebnisse der thorakalen und lumbalen spinalen Tuberkulose zu bewerten, die mit isolierter posteriorer Instrumentation ohne radikales Debridement behandelt wurden.

Methoden Diese Studie analysierte retrospektiv 73 Patienten mit thorakaler und lumbaler Spinaltuberkulose. Die Patienten wurden zwischen Januar 2012 und Dezember 2019 in unserem Krankenhaus mit isolierter posteriorer Instrumentation ohne radikales Debridement behandelt. Die Patientengruppe umfasste 42 Männer und 31 Frauen mit einem Durchschnittsalter von 67,3 ± 8,6 Jahren. Zur Bewertung der Wirbelsäulenstabilität wurde der Tuberkulose-Wirbelsäulen-Instabilitäts-Score (TSIS) verwendet. Alle Patienten erhielten nach der Operation 18 Monate lang eine Chemotherapie. Der Zeitpunkt der Operation, der Blutverlust, der visuelle Analogwert (VAS), der Kyphosewinkel, der Oswestry Disability Index (ODI), die Erythrozytensedimentationsrate (ESR), das Frankel-Grading, die SF-36-Scores sowie das lokale Rezidiv und die Komplikationen wurden analysiert, um die Wirksamkeit der isolierten posterioren Instrumentationschirurgie bei der Behandlung der thorakalen und lumbalen Wirbelsäulentuberkulose zu bewerten.

Ergebnisse Alle Patienten wurden 12 bis 24 Monate lang nachbeobachtet (Mittelwert 14 ± 3,2 Monate). Die durchschnittliche Operationszeit betrug 1,2 ± 1,4 h (Bereich, 1,2–1,6 h) und der durchschnittliche Blutverlust lag bei 107 ± 18 ml. Die postoperativen Symptome wurden offensichtlich gelindert; VAS, Kyphosewinkel, DI und ESR sanken von 8,24 ± 1,32, 19,82 ± 3,42, 46,25 ± 3,62 und 49,64 ± 17,61 auf 1,12 ± 0,21, 7,14 ± 0,81, 20,17 ± 5,11 und 0,35 ± 1,13 bei der abschließenden Untersuchung. Im Vergleich zu präoperativen Werten verbesserten sich die SF-36-Scores deutlich bei der abschließenden Nachbeobachtung und die Unterschiede waren statistisch signifikant (p < 0,05). Alle Patienten erreichten bei der letzten Nachuntersuchung eine neurologische Genesung. Bei keinem der Patienten traten Rezidive oder Komplikationen auf.

Schlussfolgerung Die isolierte posteriore Instrumentierung ohne radikales Debridement ist ein geeignetes kleines chirurgisches Trauma, das den bemerkenswerten Vorteil einer wirksamen Schmerzlinderung, einer Verbesserung der neurologischen Funktion und des Leistungsstatus bietet. Bei ausgewählten Patienten mit thorakaler und lumbaler Wirbelsäulentuberkulose traten keine Lokalrezidive oder geringere postoperative Komplikationen auf.

Schlüsselwörter

Chemotherapie - Schuldverschreibungen - Wirbelsäulentuberkulose - Chirurgie

Keywords

chemotherapy - debridement - spinal tuberculosis - surgery


Publication History

Received: 22 February 2022

Accepted after revision: 27 April 2022

Article published online:
26 July 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Khanna K, Sabharwal S. Spinal tuberculosis: a comprehensive review for the modern spine surgeon. Spine J 2019; 19: 1858-1870
    CrossrefPubMedSearch in Google Scholar
  • 2 Sun G, Wang Q, Liang Q. et al. Clinical efficacy and safety of ultra-short-course chemotherapy in treatment of spinal tuberculosis after complete debridement: an observational study. J Int Med Res 2021; 49: 300060520967611
    Search in Google Scholar
  • 3 Zhou Y, Li W, Liu J. et al. Comparison of single posterior debridement, bone grafting and instrumentation with single-stage anterior debridement, bone grafting and posterior instrumentation in the treatment of thoracic and thoracolumbar spinal tuberculosis. BMC Surg 2018; 18: 71
    CrossrefPubMedSearch in Google Scholar
  • 4 Liu Z, Zhang P, Zeng H. et al. A comparative study of single-stage transpedicular debridement, fusion, and posterior long-segment versus short-segment fixation for the treatment of thoracolumbar spinal tuberculosis in adults: minimum five year follow-up outcomes. Int Orthop 2018; 42: 1883-1890
    CrossrefPubMedSearch in Google Scholar
  • 5 Hodgson AR, Stock FE. Anterior spine fusion for the treatment of tuberculosis of the spine. J Bone Joint Surg (Am) 1960; 42: 295-310
    CrossrefPubMedSearch in Google Scholar
  • 6 Hodgson AR, Yau ACMC, Kwon JS. A clinical study of 100 consecutive cases of Pott’s paraplegia. Clin Orthop 1964; 36: 128-150
    PubMedSearch in Google Scholar
  • 7 Sinan T, Al-Khawari H, Ismail M. et al. Spinal tuberculosis: CT and MRI feature. Ann Saudi Med 2004; 24: 437-441
    CrossrefPubMedSearch in Google Scholar
  • 8 Rajasekaran S, Khandelwal G. Drug therapy in spinal tuberculosis. Eur Spine J 2013; 22 (Suppl. 04) 587-593
    CrossrefPubMedSearch in Google Scholar
  • 9 Wang B, Wang Y, Hao D. Current Study of Medicinal Chemistry for Treating Spinal Tuberculosis. Curr Med Chem 2021; 28: 5201-5212
    CrossrefPubMedSearch in Google Scholar
  • 10 Yue JJ, Sossan A, Selgrath C. et al. The treatment of unstable thoracic spine fractures with transpedicular screw instrumentation: a 3-year consecutive series. Spine (Phila Pa 1976) 2002; 27: 2782-2787
    CrossrefPubMedSearch in Google Scholar
  • 11 Sapkas G, Kateros K, Papadakis SA. et al. Treatment of unstable thoracolumbar burst fractures by indirect reduction and posterior stabilization: short-segment versus long-segment stabilization. Open Orthop J 2010; 4: 7-13
    CrossrefPubMedSearch in Google Scholar
  • 12 Zhang Z, Luo F, Zhou Q. et al. The outcomes of chemotherapy only treatment on mild spinal tuberculosis. J Orthop Surg Res 2016; 11: 49
    CrossrefPubMedSearch in Google Scholar
  • 13 Qian J, Rijiepu A, Zhu B. et al. Outcomes of radical debridement versus no debridement for the treatment of thoracic and lumbar spinal tuberculosis. Int Orthop 2016; 40: 2081-2088
    Search in Google Scholar
  • 14 Ahuja K, Kandwal P, Ifthekar S. et al. Development of Tuberculosis Spine Instability Score (TSIS): An Evidence-Based and Expert Consensus-Based Content Validation Study Among Spine Surgeons. Spine (Phila Pa 1976) 2022; 47: 242-251
    CrossrefPubMedSearch in Google Scholar
  • 15 Lue YJ, Hsieh CL, Huang MH. et al. Development of a Chinese version of the Oswestry Disability Index version 2.1. Spine (Phila Pa 1976) 2008; 33: 2354-2360
    CrossrefPubMedSearch in Google Scholar
  • 16 Bhosale S, Prabhakar A, Srivastava S. et al. Pattern of Drug Resistance in Primary Spinal Tuberculosis: A Single-Center Study From India. Global Spine J 2021; 11: 1070-1075
    CrossrefPubMedSearch in Google Scholar
  • 17 Yin XH, Liu SH, Li JS. et al. 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. Eur Spine J 2016; 25: 1047-1055
    CrossrefPubMedSearch in Google Scholar
  • 18 Güven O, Kumano K, Yalçin S. et al. A single stage posterior approach and rigid fixation for preventing kyphosis in the treatment of spinal tuberculosis. Spine (Phila Pa 1976) 1994; 19: 1039-1043
    CrossrefPubMedSearch in Google Scholar
  • 19 Chen YC, Chang MC, Wang ST. et al. One-stage posterior surgery for treatment of advanced spinal tuberculosis. J Chin Med Assoc 2003; 66: 411-417
    PubMedSearch in Google Scholar
  • 20 Kumar MN, Joseph B, Manur R. Isolated posterior instrumentation for selected cases of thoraco-lumbar spinal tuberculosis without anterior instrumentation and without anterior or posterior bone grafting. Eur Spine J 2013; 22: 624-632
    CrossrefPubMedSearch in Google Scholar