Extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHEN Shujin ^1,2 ,  MA Xiangyang ¹ , YANG Jincheng ¹ , YANG Min ¹ , ZOU Xiaobao ¹

1. Department of Spinal Surgery, General Hospital of Guangzhou Military Command of PLA, Guangzhou Guangdong, 510010, P.R.China;
2. Graduate School, Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P.R.China;

Corresponding author：

MA Xiangyang, Email: maxy1001@126.com

Keywords：

Lumbar tuberculosis; extreme lateral channel; posterior fixation

DOI：

10.7507/1002-1892.201612079

Video：

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Objective To investigate the effectiveness of extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis. Methods A retrospective analysis was made on the clinical data of 17 patients with lumbar spinal tuberculosis undergoing extreme lateral channel debridement and fusion combined with posterior fixation between December 2008 and December 2014. There were 10 males and 7 females, aged 20-69 years (mean, 42.6 years). The disease duration was 1-6 months (mean, 3.4 months). The involved segments included L_{1, 2} in 5 patients, L_{2, 3} in 6 patients, L_{3, 4} in 3 patients, and L_{4, 5} in 3 patients. Based on American Spinal Injury Association (ASIA) classification, there were 2 cases of grade C, 13 cases of grade D, and 2 cases of grade E. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Barthel index were used to evaluate the effectiveness, and the improvement rate of JOA score and Barthel index was calculated at the same time. Lumbar X-ray film and CT were taken regularly to evaluate lumbar kyphotic Cobb angle correction and bony fusion. Results The operation was successfully performed in 17 patients, and pathological examination showed tuberculosis. All cases were followed up 24-48 months (mean, 35.3 months). Lumbar X-ray film and CT showed that necrotic bone and abscess were cleared completely, and lumbar kyphosis correction was satisfactorily in all cases. Bony fusion was achieved within 6 months, and clinical cure was obtained within 18 months in all cases; no recurrence was found during follow-up period. No loosening or breakage of internal fixation was observed. At last follow-up, ASIA classification was recovered to grade D and grade E from grade C in 2 cases, to grade E from grade D in 11 cases and had no change in 2 cases (grade D). Two cases of ASIA grade E showed no neurological deficit. The VAS score, JOA score, Barthel index, and lumbar kyphotic Cobb angle were significantly improved at 2 weeks after operation and at last follow-up when compared with preoperative ones (P<0.05). At last follow-up, the improvement rate of JOA score was 75.2%±6.2% and the improvement rate of Barthel index was 75.7%±10.8%. Conclusion To use extreme lateral channel debridement and fusion combined with posterior fixation is an effective treatment for lumbar spinal tuberculosis.

Citation： CHEN Shujin, MA Xiangyang, YANG Jincheng, YANG Min, ZOU Xiaobao. Extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2017, 31(4): 455-460. doi: 10.7507/1002-1892.201612079 Copy

1.	Soares Do Brito J, Tirado A, Fernandes P. Surgical treatment of spinal tuberculosis complicated with extensive abscess. Iowa Orthop J, 2014, 34: 129-136.
2.	金大地. 脊柱结核治疗若干问题探讨. 脊柱外科杂志, 2005, 3(3): 186-188.
3.	罗鹏, 方忠, 熊伟, 等. 三种腰椎结核手术方式的比较研究. 颈腰痛杂志, 2012, 33(1): 26-29.
4.	Singh R, Magu NK. Evaluation of the Behavior of Spinal Deformities in Tuberculosis of the Spine in Adults. Asian Spine J, 2015, 9(5): 741-747.
5.	Mei G, Luo F, Zhang Z, et al. Treatment Experiences and Management Outcomes for Skipped Multisegmental Spinal Tuberculosis. Orthopedics, 2016, 39(1): e19-25.
6.	Liu P, Zhu Q, Jiang J. Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976), 2011, 36(20): E1290-1295.
7.	Ge Z, Wang Z, Wei M. Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J, 2008, 17(11): 1482-1487.
8.	He QY, Xu JZ, Zhou Q, et al. Treatment effect, postoperative complications, and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery. J Orthop Surg Res, 2015, 10: 156.
9.	张西峰, 王岩, 肖嵩华, 等. 经皮穿刺置管冲洗引流持续局部化疗治疗活动期多椎体脊柱结核. 中国脊柱脊髓杂志, 2007, 17(11): 842-845.
10.	Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior interbody fusion. Spine J, 2006, 6(4): 435-443.
11.	Barbagallo GM, Albanese V, Raich AL, et al. Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome. Evid Based Spine Care J, 2014, 5(1): 28-37.
12.	Phillips FM, Isaacs RE, Rodgers WB, et al. Adult degenerative scoliosis treated with XLIF. Spine (Phila Pa 1976), 2013, 38(21): 1853-1861.
13.	Lee YS, Kim YB, Park SW, et al. Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion: clinical and radiological results. J Kor Neurosurg Soc, 2014, 56(6): 469-474.
14.	Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S368-374.
15.	于滨生, 郑召民, 庄新明, 等. 骨质疏松程度对骶骨椎弓根螺钉固定的生物力学影响. 中国脊柱脊髓杂志, 2009, 19(10): 740-744.
16.	Street JT, Andrew Glennie R, Dea N, et al. A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine. J Neurosurgery Spine, 2016, 25(3): 332-338.

1. Soares Do Brito J, Tirado A, Fernandes P. Surgical treatment of spinal tuberculosis complicated with extensive abscess. Iowa Orthop J, 2014, 34: 129-136.
2. 金大地. 脊柱结核治疗若干问题探讨. 脊柱外科杂志, 2005, 3(3): 186-188.
3. 罗鹏, 方忠, 熊伟, 等. 三种腰椎结核手术方式的比较研究. 颈腰痛杂志, 2012, 33(1): 26-29.
4. Singh R, Magu NK. Evaluation of the Behavior of Spinal Deformities in Tuberculosis of the Spine in Adults. Asian Spine J, 2015, 9(5): 741-747.
5. Mei G, Luo F, Zhang Z, et al. Treatment Experiences and Management Outcomes for Skipped Multisegmental Spinal Tuberculosis. Orthopedics, 2016, 39(1): e19-25.
6. Liu P, Zhu Q, Jiang J. Distribution of three antituberculous drugs and their metabolites in different parts of pathological vertebrae with spinal tuberculosis. Spine (Phila Pa 1976), 2011, 36(20): E1290-1295.
7. Ge Z, Wang Z, Wei M. Measurement of the concentration of three antituberculosis drugs in the focus of spinal tuberculosis. Eur Spine J, 2008, 17(11): 1482-1487.
8. He QY, Xu JZ, Zhou Q, et al. Treatment effect, postoperative complications, and their reasons in juvenile thoracic and lumbar spinal tuberculosis surgery. J Orthop Surg Res, 2015, 10: 156.
9. 张西峰, 王岩, 肖嵩华, 等. 经皮穿刺置管冲洗引流持续局部化疗治疗活动期多椎体脊柱结核. 中国脊柱脊髓杂志, 2007, 17(11): 842-845.
10. Ozgur BM, Aryan HE, Pimenta L, et al. Extreme Lateral Interbody Fusion (XLIF): a novel surgical technique for anterior interbody fusion. Spine J, 2006, 6(4): 435-443.
11. Barbagallo GM, Albanese V, Raich AL, et al. Lumbar lateral interbody fusion (LLIF): comparative effectiveness and safety versus PLIF/TLIF and predictive factors affecting LLIF outcome. Evid Based Spine Care J, 2014, 5(1): 28-37.
12. Phillips FM, Isaacs RE, Rodgers WB, et al. Adult degenerative scoliosis treated with XLIF. Spine (Phila Pa 1976), 2013, 38(21): 1853-1861.
13. Lee YS, Kim YB, Park SW, et al. Comparison of transforaminal lumbar interbody fusion with direct lumbar interbody fusion: clinical and radiological results. J Kor Neurosurg Soc, 2014, 56(6): 469-474.
14. Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S368-374.
15. 于滨生, 郑召民, 庄新明, 等. 骨质疏松程度对骶骨椎弓根螺钉固定的生物力学影响. 中国脊柱脊髓杂志, 2009, 19(10): 740-744.
16. Street JT, Andrew Glennie R, Dea N, et al. A comparison of the Wiltse versus midline approaches in degenerative conditions of the lumbar spine. J Neurosurgery Spine, 2016, 25(3): 332-338.

Chinese Journal of Reparative and Reconstructive Surgery

Extreme lateral channel debridement and fusion combined with posterior fixation for lumbar spinal tuberculosis

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