ABSTRACT
Objective To evaluate the efficacy and safety of one-stage posterior wedge osteotomy ffor correction ot kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Methods From January 2002 to December 2012,we retrospectively reviewed 18 patients with tuberculosis of the spine in healed stages which underwent one-stage posterior wedge osteotomy.There were 6 males and 12 females,whose average age was 8.2 (4 to 15) years and average followed-up time was 37.1 (10 to 120) months.The apical vertebrae were located at cervicothoracic segment in 2 cases,thoracic segment in 10 cases,thoracolumbar segment in 5 cases and lumbar segment in 1 case.The lesions involved 2 segments in 3 cases,3 to 5 segments in 9 cases and more than 5 segments in 6 cases.There were 6 cases with neurological dysfunction whose Frankel' s classification was C in 2 cases and D in 4 cases.The coronal and sagittal Cobb angels,thoracic kyphosis,lumbar lordosis,sagittal trunk shifts,number of fixation and fusion segments and bony union were measured on the standing AP and lateral radiographs before,after surgery and at the final follow-up.Results The Cobb' s angels in the sagittal plane were corrected from 71.6° to 14.5°,representing 79.7％ correction rate.The Cobb' s angels in the coronal plane were corrected from 9.4° to 0.7°.Sagittal trunk shift was obviously improved from 3.7mm to 0.5mm.The average fixation segment was 9.6 (5 to 17) segments while the average fusion segment was 4.4 (2 to 8) segments.The neurological function had all been improved at final follow-up.Perioperative complications consisted of fixation loosening in 4 cases,gastrointestinal dysfunction in 2 cases,pleura injury in 5 cases,and cerebrospinal fluid leakage in 3 cases.Conclusion One-stage posterior wedge osteotomy is a safe and effective surgical technique for correction of kyphosis or kyphoscoliosis in children with healed stages of spinal tuberculosis.Both the selection of fusion levels and the appropriate technique of osteotomy are crucial to good outcomes.
ABSTRACT
Objective To study the clinical,laboratory,imaging characteristics and surgical outcomes of Brucellar spondylitis.Methods The clinical,laboratory,imaging characteristics and surgical outcomes of 27 patients with Brucella spondylitis were analyzed in our department from September 2000 to December 2010.There were 18 males and 9 females,aged from 23 to 57 years(average,32.8 years ).There were 3 cases in cervical vertebra,8 cases in thoracolumbar vertebra,16 cases in lumbosacral vertebra respectively.Before admission,17 patients were misdiagnosed as tuberculosis,2 ones were as postoperative change of lumbar disc herniation.Eight patients underwent posterior debridement,autologous bone grafting and instrumentation,19 cases were treated with anterior debridement,autologous bone grafting and instrumentation.Streptomycin was placed in localized lesions for 24 patients,except for 3 cases whose streptomycin skin test positive.External fixation brace were used for 4 to 6 weeks,oral medication was used for a half month to 3 months.Clinical evaluation included clinical cure rate,pain visual analog scale (VAS) and the fusion rate.Results All of 27 patients were followed up for an average of 19.7 months (range,6 to 48 months).According to evaluation standard for Brucella spondylitis,24 patients were cured,3 patients got improvement.Three patients underwent the second operation owing to wound infection and sinus formation.Conclusion The pain of spine with intermittent fever,the imaging features as well as positive serum agglutination test can confirm the diagnosis of Brucellar spondylitis.Operation should be considered in patients with persistent pain and neurologic disorders as well as systemic symptoms.Instrumentation is effective and safe in the treatment of patients with spinal brucellosis following debridement,autogenous bone grafting,combined with antibiotic therapy.