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BACKGROUND: Animal model experiments on bone tuberculosis showed that calcium sulfate artificial bone loading could slowly and permanently release antituberculosis drugs, increase local drug concentration, and repair local bone defects and promote bone fusion. OBJECTIVE: To evaluate the safety and efficacy of implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw in the treatment of lumbar tuberculosis under transforaminal endoscopy after removal of lesions. METHODS: Twenty-eight patients with lumbar spinal tuberculosis who were treated in the First Affiliated Hospital of Guangxi University of Chinese Medicine from July 2016 to June 2019 were selected, including 10 males and 18 females, at the age of 36-69 years. Twelve patients in the experimental group received implantation of artificial bone with streptomycin sulfate and posterior percutaneous pedicle screw under transforaminal endoscopy after removal of lesions. Sixteen patients in the control group received bone graft fusion and internal fixation under anterior and posterior combined approach or bone graft fusion and internal fixation after posterior approach. Operation time, intraoperative blood loss, and hospital stay were recorded. At 3 months postoperatively and at the last follow-up, erythrocyte precipitation, C-reactive protein level and Cobb angle, visual analogue scale score, lumbar Japanese Orthopaedic Association score and Oswestry disability index score were compared between the two groups. The experiment was approved by the Ethics Committee of First Affiliated Hospital of Guangxi University of Chinese Medicine. RESULTS AND CONCLUSION: (1) The operation time, intraoperative blood loss and hospital stay in the experimental group were all less than those in the control group (P 0.05). (5) The results show that compared with the traditional posterior approach and combined anterior and posterior approaches in the treatment of lumbar tuberculosis, posterior lateral foramen endoscopic implantation of artificial bone with streptomycin sulfate combined with posterior percutaneous pedicle screw fixation can also achieve satisfactory clinical effect, and has the advantages of small trauma and rapid recovery.
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BACKGROUND: Conventional anterior debridement and bone graft fusion for lumbar spinal tuberculosis have a great trauma, and bring more complications. The double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can significantly improve the prognosis of lumbar spinal tuberculosis. There is no clinical study to compare the efficacy between the two surgical methods. OBJECTIVE: To compare the efficacy of lumbar spinal tuberculosis via anterior double titanium mesh support bone graft combined with posterior pedicle internal fixation and conventional anterior debridement and bone graft fusion. METHODS: Case history data of 40 patients with lumbar spinal tuberculosis were retrospectively collected from the Department of Spinal Surgery, Mianyang Central Hospital, Southwest Medical University from May 2015 to March 2018. The patients were divided into experimental group and control group (n=20) according to the operation. Patients in the experimental group were treated with the anterior double titanium mesh support bone graft combined with the posterior pedicle screw fixation reconstruction. Patients in the control group were treated with anterior debridement and bone graft fusion. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. RESULTS AND CONCLUTION: (1) Lumbar spinal tuberculosis could be effectively treated with both surgical methods. (2) Compared with the control group, the operation time was shorter; the intraoperative blood loss was less; and the bone graft fusion was faster in the experimental group. (3) With prolongation of the postoperative time, the erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment gradually decreased in the two groups. The erythrocyte sedimentation rate and the sagittal Cobb angle of the lesion segment in the experimental group were slightly lower than those in the control group. (4) After treatment, the classification of the American Spinal Cord Injury Association was improved in some patients. (5) The incidence of adverse reactions in the experimental group was lower than that of the control group. (6) The results suggest that double titanium mesh support bone graft combined with posterior pedicle internal fixation reconstruction can effectively improve the stability of the diseased vertebrae, and the treatment effect on lumbar spinal tuberculosis is better than conventional anterior lesion removal and bone graft fusion internal fixation.
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[Objective]To analyze the feasibility and clinical efficacy of one-stage debridement,bone grafting and in-ternal fixation for the treatment of single-segmental lumbar spinal tuberculosis with extreme lateral approach.[Methods]Thirteen patients of single-segmental lumbar spinal tuberculosis that received the surgeries from April 2013 to August 2016 were included.The operation duration and the amount of intraoperative blood loss were recorded.The VAS and ODI of the back pain,lumbar kyphosis angle,segment height restoration,and vertebral fusion rate were used to analyze the clinical efficacy.[Results]Thirteen patients were successfully followed up for 13-32 months(mean,20.3 months);the operation duration was 160-280 min(average,214±96)min;the amount of intraoperative blood loss was 150-350 mL, average(average,263±63)mL. At the final follow-up,ESR and CRP were normal and lower back pain(VAS)and Oswestry disability index(ODI)were significantly reduced(7.2±1.6 vs 2.5±1.2 and 63.3±5.4 vs 31.9±3.7,respectively)compared to preoperative values;there were no significant difference in the lumbar kyphosis angle,segment height resto-ration between preoperation(segmental lordosis,7.1°±4.7°;segmental height,64.8 mm±9.3 mm)and the values at final follow-ups(segmental lordosis,5.2°±3.5°;segmental height,69.4 mm±10.5 mm;P>0.05). All cases acquired good lumbar interbody fusion with no internal fixation failure or recurrence of tuberculosis.[Conclusions]Under systemic and routine antituberculosis chemotherapy,one-stage extreme lateral approach debridement,bone graft and internal fixation is effective and feasible for single-segmental lumbar spinal tuberculosis.
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Objective To explore the therapeutic efficacy of posterior internal fixation and anterior debride-ment with autogenous bone grafts at one stage on tuberculosis of thoracic or lumbar spine . Methods 16 cases of thoracic or lumbar spinal tuberculosis patients were treated with combined anterior (radical debridement and bone autograft) and posterior (instrumentation) surgeries in one stage between September 2003 and September 2007. The degree of the kyphosis (Cobb angle) was measured and the interbody fusion was observed preoperatively and postop-eratively. The ASIA grading system was used to assess the neurological status. Results All patients were followed up for 10 months to 36 months,on average of 12 months. All patients showed sucessful interbedy fusion,but Cobb angle was not progressed. No recurrence or wound infection was found. 6 cases all got nerve function recovery. Conclusion Thoracic or lumbar tuberculosis treated with this surgical technique can achieve stable internal fixation and a high satisfactory rate with restoring the spinal stability, arresting the disease early, providing early fusion, correcting the ky-pbosis particularly.
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[Objective]To evaluate the short-term and long-term effectiveness of the surgical technique of one-stage one-step surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and autograft bone graft fusion in the treatment thoraco-lumbar spinal tuberculosis with kyphotic deformity.[Method]The outcome of sixty eight cases suffered from thoraco-lumbar spinal tuberculasis with kyphotic deformity between July 1998 and March 2004 managed by the surgical techniques of Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debridement and antograft bone graft fusion through posteroiateral costotransversectomy or kidney incision was analyzed.All cases wer given a longitudinal study follow-up for a mean of 3.3(2.2~6.3)years postoperatively.[Result]All patients showed successful autograft bone graft fusion.Among 45 cases accompanied with neurotic symptom of Potts paraplegia,25 were completely recovered,15 were partly recovered,total the ratio of recovery was 88.89% at the end of postoperative follow-up.The average immediate postoperative correction of kyphosis angle was 28.9?,the average loss of correction was only 2.7? at final follow-up.[Conclusion]The surgical technique of one-stage one-step Z-plate-Ⅱ~(TM) internal fixation apparatus system and anterior debrideraent and autograft bone graft fusion is found helpful in strengthening the stability of the spine in thoraco-lumbar spinal tuberculosis with kyphotic deformity,providing successful interbody fusion and recovery of Potts paraplegia,correcting the kyphosis,and preventing progress of kyphosis.