Résumé
Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
Résumé
Objective To investigate the 18F-FDG PET/CT imaging features of thoracolumbar tuberculosis.Methods Nine-ty-eight patients with thoracolumbar vertebral column destruction receiving 18F-FDG PET/CT examination in our hospital from May 2005 to January 2017 were selected as the study subjects and divided into the tuberculosis(TB) group (n=27) and non-TB group (n=71) according to the result of pathology examination and follow-up.The 18F-FDG PET/CT signs were compared between the two groups,and the binary classification Logistic regression was used to screen out the signs with statistical significance.Results Forty-two lesions and 114 lesions were detected in the TB group and non-TB group respectively.The incidence rates of continuous vertebral body involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess," radioactive cold area",high lesion SUVmax and slightly higher SUVmax sign in the TB group were higher than those in the non-TB group(P＜ 0.05) The binary classification Logistic regression analysis results showed that continuous vertebral involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess and "radioactive cold area" were the independent factors for diagnosis of thoracolumbar TB(P＜0.05).The sensitivity,specificity,positive prediction value,negative predictionvalue and Youden index in the combination of continuous vertebral involvement + intervertebral disc lesion were 71.4％,81.6％,58.8％,88.6％,53.0％,respectively.Conclusion For the diagnosis of thoracolumbar TB,the combination of continuous vertebral involvement + intervertebral disc lesion has the highest diagnostic value.
Résumé
Objective To explore the clinical application of one-stage surgery combined posterior inter-fix-ation and anterior debridement for thoracolumbar tuberculosis in children. Methods The clinical data of thoraco-lumbar tuberculosis in children treated by combined surgery of posterior and anterior approach from January 2006 to December 2014 was reviewed retrospectively. The enrolled patients were divided into group A(25 patients under-went one-stage surgery)and group B(16 patients underwent two-stage surgery). Operation time,blood loss and complications were compared. The clinical effectiveness was evaluated by using visual analogue scale(VAS), kyphotic angle,neurological function(ASIA)and bone fusion. Results All operations completed successfully. There was statistically significance between two groups regarding to operation time [(202 ± 50)min vs. (254 ± 46)min]and blood loss[(332 ± 162)mL vs.(432 ± 106)mL]. The follow-up of 12 ~ 60 months indicated that bone grafts were fused without instrumentation failure. For patients with spinal cord injury ,there was 1 or 2 grades improvement by ASIA grading. VAS and the kyphotic angle were improved after operation ,but there was no statisti-cally significance between two groups regarding to the efficiency. Conclusions One-stage surgery combined pos-terior and anterior approach is a safe and effective method for thoracolumbar tuberculosis in children for immediate stability of spine,less blood loss and shorter operation time.
Résumé
Objective To explore the clinical efficacy of one-stage anterolateral-posterior approach debridement,bone graft and internal fixation in treatment of thoracolumbar spinal tuberculosis.Methods From January 2010 to December 2014,56 cases of thoracolumbar spinal tuberculosis were retrospectively analyzed, including 31 males and 25 females,aged 18 -72 years (mean 43.1 years).All patients were managed by standard courses of chemotherapy with quadruple anti-TB drugs for 2 - 4 weeks.Patients were treated by anterolateral debridement,autologous iliac bone graft fixed by absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach).We recorded the operation time,the amount of bleeding,bone graft fusion,postoperative erythrocyte sedimentation rate (ESR),Cobb angle,VAS score,and American Spinal Injury Association (ASIA)score to evaluate the surgical results.Results The average operation time was 175-290 min, with an average of (248±42)min.The bleeding volume was 300 -900 mL with an average of (420 ±68)mL.The average follow-up time was (24 ± 5.2 )months,bone fusion rate was 100%,and fusion time was (4.7 ± 0.5 ) months.At the last follow-up,the average Cobb angle was (8.2±3.1)°,VAS was (2.1±0.8),and ESR was (17± 4.2)mm/h.The ASIA neurological functions were all classified as Grade E except for 3 cases of Grade D.All these were significantly different from the preoperative ones.Six patients had complications of different degree but without serious complications.Conclusion One-stage anterolateral debridement,autologous iliac bone graft fixedby absorbable screw fixation,and posterior pedicle screw fixation via multi-split muscle gap (Wiltse approach)can completely remove the tuberculosis lesions and achieve ideal kyphosis correction,high bone graft fusion,and satisfactory neurological function recovery.Absorbable screws can be safely applied to the bone graft site after debridement.
Résumé
Objective To investigate the 18F-FDG PET/CT imaging features of thoracolumbar tuberculosis.Methods Nine-ty-eight patients with thoracolumbar vertebral column destruction receiving 18F-FDG PET/CT examination in our hospital from May 2005 to January 2017 were selected as the study subjects and divided into the tuberculosis(TB) group (n=27) and non-TB group (n=71) according to the result of pathology examination and follow-up.The 18F-FDG PET/CT signs were compared between the two groups,and the binary classification Logistic regression was used to screen out the signs with statistical significance.Results Forty-two lesions and 114 lesions were detected in the TB group and non-TB group respectively.The incidence rates of continuous vertebral body involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess," radioactive cold area",high lesion SUVmax and slightly higher SUVmax sign in the TB group were higher than those in the non-TB group(P＜ 0.05) The binary classification Logistic regression analysis results showed that continuous vertebral involvement,intervertebral disc lesion,vertebral body compression fractures,cold abscess and "radioactive cold area" were the independent factors for diagnosis of thoracolumbar TB(P＜0.05).The sensitivity,specificity,positive prediction value,negative predictionvalue and Youden index in the combination of continuous vertebral involvement + intervertebral disc lesion were 71.4％,81.6％,58.8％,88.6％,53.0％,respectively.Conclusion For the diagnosis of thoracolumbar TB,the combination of continuous vertebral involvement + intervertebral disc lesion has the highest diagnostic value.
Résumé
Objective To explore the clinical application of one-stage surgery combined posterior inter-fix-ation and anterior debridement for thoracolumbar tuberculosis in children. Methods The clinical data of thoraco-lumbar tuberculosis in children treated by combined surgery of posterior and anterior approach from January 2006 to December 2014 was reviewed retrospectively. The enrolled patients were divided into group A(25 patients under-went one-stage surgery)and group B(16 patients underwent two-stage surgery). Operation time,blood loss and complications were compared. The clinical effectiveness was evaluated by using visual analogue scale(VAS), kyphotic angle,neurological function(ASIA)and bone fusion. Results All operations completed successfully. There was statistically significance between two groups regarding to operation time [(202 ± 50)min vs. (254 ± 46)min]and blood loss[(332 ± 162)mL vs.(432 ± 106)mL]. The follow-up of 12 ~ 60 months indicated that bone grafts were fused without instrumentation failure. For patients with spinal cord injury ,there was 1 or 2 grades improvement by ASIA grading. VAS and the kyphotic angle were improved after operation ,but there was no statisti-cally significance between two groups regarding to the efficiency. Conclusions One-stage surgery combined pos-terior and anterior approach is a safe and effective method for thoracolumbar tuberculosis in children for immediate stability of spine,less blood loss and shorter operation time.
Résumé
Objective To observe the therapeutical effect of posterior vertebral column resection on chronic thoracolumbar tuberculosis with secondary paraplegia and to provide a safe and effective method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.MethodsFrom Aug.2007 to Mar.2010,12 cases with chronic thoracolumbar tuberculosis and secondary paraplegia were surgically treated by posterior vertebral column resection and Titanium net support for bone graft and internal fixation operation treatment.Cobb angle was measured,and conditions of internal fixation were observed before and after the operation by X-ray films.Neurological status were evaluated by Frankel grades.ResultsThe follow-up periods was 6- 18 months( on average 11 months).Operations eased all patients' back and chest pain.Frankel grade increased from C preoperatively to grade D or E postoperatively in 6 cases,from grade D to E in 4 cases and from grade B to C in 1 case.No obvious improvement of Frankel grade was observed in the other patient of grade B.The average Cobb angles were(76.0 ± 23.4) ° before surgery,( 15.5 ± 6.3 ) ° at one week after surgery and ( 16.0 ± 8.2) °at the last follow-up.The difference in the Cobb angle before and at one week after treatment was significant( t =3.41,P ＜ 0.01 ).No difference was found in the Cobb angle between at one week after treatment and at the last follow-up (t =1.58,P ＞ 0.05 ).All patients got bony fusion with Titanium net.No complications occurred with internal fixation.Conclusion Posterior vertebral column resection is a feasible method for the treatment of chronic thoracolumbar tuberculosis with secondary paraplegia.It achieves neurological decompression with high correction rate and minor injury,and no anterior surgery is needed.