Surgical treatment of lumbosacral tuberculosis by anterior debridement,bone graft,and posterior pedicle screw-rod internal fixation / 中国骨伤

<p><b>OBJECTIVE</b>To investigate the effectiveness of anterior debridement,bone graft, and posterior pedicle screw-rod internal fixation in the treatment of lumbosacral tuberculosis.</p><p><b>METHODS</b>From January 2005 to June 2012,18 patients with lumbosacral tuberculosis undergoing the surgical treatment by anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation were reviewed retrospectively. There were 12 males and 6 females with an average age of 44 years old ranging from 35 to 67. Among them, 2 cases were simple low back pain,3 cases were low back pain combined with radiating pain of lower extremity and 13 cases were muscle strength hypesthesia. According to Fankle grading,the nerve function was grade C in 3 cases,grade D in 10 cases,grade E in 5 cases. Of these cases,L4.5 was involved in 8 cases,L5 in 4 cases and L5S1 in 6 cases. The lumbosacral angle was 150 to 270 and the erythrocyte sedimentation rate (ESR) was 45 to 93 mm/h before treatment. The clinical indexes including the lumbosacral incidence, Frankel grade and ESR were reviewed at follow-up.</p><p><b>RESULTS</b>All 18 cases were followed up for 14 to 22 months. The mean operation time was 180 min. The amount of bleeding was 400 to 800 ml. Except 1 case with iliac vein injuried and 4 cases with abdominal distension,no spinal injuries and severe relative complication occurred, and neurologic function improved in various degrees. Pain in lumbosacral area and radicular pain in lower extremities disappeared. The X-ray and CT films demonstrated that bony fusion was obtained in all patients during 9 to 13 months postoperatively. The lumbosacral angle and ESR were improved significantly.</p><p><b>CONCLUSION</b>Anterior debridement, bone graft, and posterior pedicle screw-rod internal fixation is an effective method in dealing with lumbosacral spine tuberculosis.</p>

Case-control study on therapeutic effects between posterior corpectomy, decompression and reconstruction and combined anterior-posterior surgery for the treatment of severe thoracolumbar fractures with incomplete paraplegia / 中国骨伤

<p><b>OBJECTIVE</b>To compare the clinical outcome between posterior corpectomy, decompression and reconstruction and combined anterior-posterior surgery in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia, and to provide a basis for procedure selection.</p><p><b>METHODS</b>Clinical and radiographic results of posterior corpectomy, decompression and reconstruction (group A) and combined anterior-posterior surgery (group B) in the treatment of severe thoracolumbar three column fractures with incomplete paraplegia were analyzed retrospectively from January 2008 to December 2012. In group A, there were 18 patients (10 males and 8 females). The fractures were located on T11 in 1 case, T12 in 5 cases, L1 in 6 cases and L2 in 6 cases. In group B, there were 15 patients (9 males and 6 females). The fractures were located on T1 in 1 case, T12 in 5 cases, L1 in 5 cases and L2 in 4 cases. Neurological status was judged by Frankel grades. The X-ray and CT were used for evaluation of the restoration of anterior height of the fractured vertebral body, the correction of Cobbs angle, the decompression scope of spinal canal and the fusion. Complications related to operation were also considered. Results: The followup periods ranged from 12 to 18 months (averaged 16 months). The mean operation time, perioperative bleeding, postoperative drainage were (200 ± 43) min, (1100 ± 344) ml, and (400 ± 112) ml respectively in group A; and (290 ± 68) min, (1 500 ± 489) ml, (900 ± 269) ml respectively in group B. There was statistically significant difference between groups A and B (P < 0.05). There were significant improvements in anterior height of fractured vertebral body and Cobbs angle after operation. But there was no significant difference between groups A and B (P > 0.05). In Frankel grades, all patients had one grade or more improvement postoperatively. There was no significant difference between two groups (P > 0.05).</p><p><b>CONCLUSION</b>Treatment of thoracolumbar vertebra burst fractures with subtotal vertebrectomy, decompression and reconstruction of anterior column through posterior approach has a similar clinical result compared to the operation through combined anterior and posterior approach, but the posterior surgery decreased surgical trauma. It is an effective and safe surgical method.</p>