ABSTRACT
A case of Pott’s paraplegia of sudden onset and of more than two months duration in an aged female, treated by a novel surgical technique of anterior decompression and local kyphotic angle correction by spinal pedicular fixation is presented here. A 52 year female with Pott’s paraplegia, ASIA-A with sphincters involvement and with flexor spasm, was treated by surgical intervention, in a single operation of two stages, the first by provisional posterior pedicular fixation and the second stage by anterolateral decompression and correcting the local kyphotic angle by cyclic changing the rods in increments of 5 degrees in compressive mode. The paravertebral abscess of opposite side was sucked out and at the end a tricortical bone graft harvested from iliac crest was impacted in between the space created by pedicular fixation maneuver in course of correcting kyphosis. There was steady dramatic improvement of clinical and neurological status within three weeks. Kyphotic correction was maintained with anterior tricortical interbody bone graft impacted in position. The novel surgical technique that is adopted for decompression, drainage including paravertebral abscess of opposite side, debridement and local kyphotic angle correction along with interbody bone graft fusion, in this case, offered a satisfactory outcome in spite of poor prognostic factors.
ABSTRACT
Objective:To determine the clinical efficacy of posterior intervertebral surgery for single-segment thoracolumbar spinal tuberculosis.Methods:Clinical data were retrospectively analyzed in 62 patients with thoracolumbar spinal tuberculosis who underwent posterior intervertebral surgery (A group) or posterior and anterior combined intervertebral surgery (B group) from January 2010 to January 2015 in Department of Spinal Surgery,General Hospital,Ningxia Medical University.The operative time,blood loss,length of hospital stay,erythrocyte sedimentation rate (ESR),C-reactive protein (CRP) level,neurological function,VAS score,vertebral Cobb angle,bone healing,and postoperative complications were compared between the 2 groups.Results:All patients were followed up for 10 to 30 (average 22) months after the operation.In the A group,operative time,blood loss,and hospital stay were less than those in the B group (P＜0.05).In the follow-up,the pain of patients was alleviated and nervous function was improved obviously in the 2 groups compared with pre-operation.The ESR and CRP at the 6 months after operation returned to the normal range in patients of the 2 groups.There were significant differences in the ESR and CRP among the pre-operation,the 6 months after operation,and the end of follow-up within the group (P＜0.05),while there were no significant differences in ESR and CRP between the 6 months after operation and the end of follow-up (P＞0.05).There were no significant differences in the ESR and CRP among the pre-operation,the 6 months after operation,and the end of follow-up in the 2 group (P＞0.05).The Cobb angles after the operation and the end of follow-up were significanthy smaller than those before the operation (P＜0.01),while there were no significant differences in Cobb angle before operation,after the operation,and the end of follow-up between the 2 groups (P＞0.05).There were no significant differences in the bone healing rate at 6 months or 1 year after operation between the A group and B group (P＞0.05) and the complication rate of the A group was lower than the B group (P＜0.01).Conclusion:Clinical efficacy of posterior intervertebral surgery is satisfatory in treating single-segment thoracolumbar spinal tuberculosis with less complications.
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OBJECTIVE:To observe the effects of different routes of administration of tranexamic acid on coagulation function and amount of bleeding in patients with one stage posterior surgery of thoracic tuberculosis. METHODS:40 patients suffered from thoracic tuberculosis in our hospital from Jan. 2011 to Dec. 2013 were randomly divided into intravenous group(5% Glucose injec-tion 100 ml+tranexamic acid 10 mg/kg,through an intravenous drip at 30 min before closing the wound) and topical application group(5% Glucose injection 10 ml and tranexamic acid 10 mg/kg,through soaking the wound before closing the wound)with 20 cases in each group. Other 15 cases suffered from the thoracic tuberculosis in our hospital from Jan. 2009 to Dec. 2010 were includ-ed in control group. 3 groups received one stage posterior surgery of thoracic tuberculosis,interbody fusion and internal fixation. The difference of hemoglobin,coagulation function and the amount of suction drainage were observed before and after surgery, and followed up. Bone graft fusion and therapeutic condition of tuberculosis were observed in the study. RESULTS:There was no statistical significance in postoperative suction drainage between intravenous group and topical application group (P>0.05),but their decrease was more significant than control group,with statistical significance(P0.05). The difference value of he-moglobin in control group before and after operation was significantly higher than in intravenous group and topical application group,with statistical significance (P0.05). 55 patients were all followed up and bone graft of all cases were fused,and all patients were cured and no case recurred. CONCLUSIONS:Tranexamic acid by intravenous application or topical application can reduce hemorrhage and ane-mia after operation of thoracic tuberculosis,and has no effect on blood coagulative system.
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PURPOSE: Diagnosis of tuberculosis (TB) in children is more challenging than in adults. This study aimed to describe demographical, clinical and laboratory findings of children diagnosed with tuberculosis in Turkey, including the issues of contact tracing, culture positivity and forms of the disease. MATERIALS AND METHODS: Clinical and laboratory data of 51 children with a mean age of 8.0+/-4.6 years who were diagnosed with TB were retrospectively reviewed. Main diagnostic tools included tuberculin skin test, chest X-ray, sputum/gastric aspirate culture with sensitivity testing, and direct microscopy for acid-fast bacilli on available samples. Clinical characteristics and outcomes of the patients were examined. RESULTS: Thirty-six (70.6%) children were diagnosed with intra-thoracic and 15 (29.4%) with extra-thoracic tuberculosis. Twenty-eight of the patients had a positive Bacillus Calmette-Guerin vaccine scar (28/51, 54.9%) and 23/51 (45.1%) had a positive tuberculin skin test. An adult TB contact was identified in 27 (52.9%) of the cases. On direct microscopy, acid-fast bacilli were found in nine (17.6%) patients and positive culture for Mycobacterium tuberculosis was found in 19 (37.3%). Drug resistance to isoniazid was detected in four (7.8%). One patient with nephrotic syndrome and miliary tuberculosis died during follow-up. All other patients responded well to the treatment. CONCLUSION: Focusing on active contact tracing among all household contacts of tuberculous cases may be helpful in early identification and controlling childhood disease, even in regions with low disease prevalence. Adopting a suspicious and proactive approach in this particular age group is warranted.