ObjectiveTo investigate the effectiveness of retroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis. MethodsA retrospective analysis was made on the cl inical data of 22 patients with lumbar spine tuberculosis undergoing focus clearance, fusion, and internal fixation by retroperitoneal laparoscopic approach combined with anterolateral mini-incision between June 2006 and June 2012. There were 14 males and 8 females, with an average age of 42.6 years (range, 26-57 years) and with a mean disease duration of 7.3 months (range, 3-10 months). There were 17 patients with single-level spinal tuberculosis (L1, 2 in 3, L2, 3 in 6, L3, 4 in 4, L4, 5 in 2, and L5 in 2) and 5 patients with double-level spinal tuberculosis (L1-3 in 2 and L2-4 in 3). The preoperative Cobb's angle of lumbar spine was 5-28° (mean, 20°). In 6 patients having compression symptom, 4 cases were rated as grade D and 2 as grade C according to Frankel classification. The operative time, intraoperative blood loss, and postoperative complications were recorded. At last follow-up, the neurologic function was assessed according to Frankel grade, the Cobb's angle after operation was measured on lumbar lateral X-ray film; the efficacy was evaluated according to Nakai criteria, and the fusion was evaluated according to Suk criteria. ResultsAll operations were successfully completed. The operation time was 110-250 minutes (mean, 140 minutes), and intraoperative blood loss was 120-280 mL (mean, 180 mL). The symptoms of femoral nerve injury and sympathetic nerve injury occurred in 1 case respectively and was relieved at 1-3 weeks after operation. All incisions healed by first intention. The patients were followed up 16-50 months (mean, 21 months). During the follow-up period, no loosening or breakage of implants and no tuberculosis recurrence were found. At last follow-up, the nerve function was recovered to grade E in the others except 1 case at grade D. The Cobb's angle was 2-16° (mean, 7.8°). According to Nakai criteria for efficacy evaluation, the results were excellent in 9 cases, good in 10 cases, and fair in 3 cases, with an excellent and good rate of 86.4%. The bony fusion rate was 95.5% (21/22) according to Suk criteria. ConclusionRetroperitoneal laparoscopic approach combined with anterolateral mini-incision for lumbar spine tuberculosis is a safe and effective approach with minimal invasion and less complications.
ObjectiveTo explore the efficacy of percutaneous pedicle screw internal fixation and minimally invasive lateral small incisions lesion debridement and bone graft fusion via dilated channels in the treatment of lumbar tuberculosis.MethodsThe clinical data of 22 cases of lumbar tuberculosis treated with percutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incision lesion debridement and bone graft fusion between January 2016 and June 2018 were retrospectively analyzed. There were 12 males and 10 females, with an average age of 47.5 years (range, 22-75 years). The affected segments were L2, 3 in 5 cases, L3, 4 in 8 cases, and L4, 5 in 9 cases, with an average disease duration of 8.6 months (range, 4-14 months). Preoperative neurological function was classified according to the American Spinal Injury Association (ASIA), with 3 cases of grade C, 9 cases of grade D, and 10 cases of grade E. The operation time, intraoperative blood loss, and postoperative complications were recorded. At preoperation, 3 months after operation, and last follow-up, the C reactive protein (CRP) and erythrocyte sedimen- tation rate (ESR) were tested to evaluate tuberculosis control; the pain visual analogue scale (VAS) score was used to evaluate the recovery of pain, and the Oswestry disability index (ODI) was used to evaluate the function recovery of the patient’s lower back; the kyphosis Cobb angle was measured, and the loss of Cobb angle (the difference between the Cobb angle at last follow-up and 3 months after operation) was calculated. At last follow-up, the ASIA classification was used to evaluate the recovery of neurological function, and the effectiveness was evaluated according to the modified MacNab standard.ResultsThe operation time was 110-148 minutes (mean, 132.8 minutes) and the intraoperative blood loss was 70-110 mL (mean, 89.9 mL). Two patients experienced fat liquefaction of the incision and delayed healing; the incisions of the remaining patients healed by first intention. All patients were followed up 18-24 months, with an average of 21.3 months. All bone grafts achieved osseous fusion, the pedicle screws were fixed in reliable positions, without loosening, displacement, or broken rods. There was no recurrence of tuberculosis. The ESR, CRP, VAS scores, ODI scores, and kyphosis Cobb angle of the affected segment at 3 months after operation and last follow-up were significantly improved (P<0.05); there were no significant differences between at last follow-up and 3 months after operation (P>0.05), and the loss of Cobb angle was (0.6±0.5)°. The patient’s neurological function recovered significantly. At last follow-up, the ASIA grades were classified into 1 case with grade C, 1 case with grade D, and 20 cases with grade E, which were significantly improved when compared with preoperative grading (Z=−3.066, P=0.002). According to the modified MacNab standard, 16 cases were excellent, 3 cases were good, 2 cases were fair, and 1 case was poor. The excellent and good rate was 86.4%.ConclusionPercutaneous pedicle screw internal fixation combined with dilated channels with minimally invasive lateral small incisions lesion debridement and bone graft fusion has the advantages of less bleeding, less trauma, and faster recovery, which is safe and effective in the treatment of lumbar tuberculosis.
ObjectiveTo investigate the value of small incision approach in the anterior surgery of thoracic and lumbar spinal tuberculosis.MethodsA clinical data of 65 patients with thoracic or lumbar spinal tuberculosis treated with posterior-anterior surgery between January 2015 and January 2018 was retrospectively analyzed. The patients were divided into small incision group (group A, 29 patients) and traditional incision group (group B, 36 patients) according to the length of anterior incision. There was no significant difference in general data such as gender, age, disease duration, segment of lesion, American Spinal Cord Injury Association (ASIA) grading, preoperative pain visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and Cobb angle of spinal kyphosis between 2 groups (P>0.05). The length of anterior incision, operation time, intraoperative blood loss, postoperative complications, postoperative hospitalization time, ESR, and CRP were recorded and compared. The VAS score was used to evaluate the pain after operation. The Cobb angles in patients with spinal kyphosis were measured and the loss of angle and correction rate of angle were calculated. The result of bone graft fusion was assessed according to the Bridwell standard.ResultsThe length of anterior incision, operation time, intraoperative blood loss, and hospitalization time of group A were all significantly less than those of group B (P<0.05). All patients in both groups were followed up 12-29 months (mean, 20 months). There were 4 cases (13.8%) and 14 cases (38.9%) of postoperative complications in groups A and B respectively, showing significant difference (χ2=5.050, P=0.025). The ESR and CRP in 2 groups all returned to normal at 6 months after operation, and there was no significant difference in ESR and CRP between 2 groups at 3 months, 6 months, and last follow-up (P>0.05). At last follow-up, the neurological function of patient with neurological symptoms was significantly better than that before operation, and there was no significant difference between 2 groups (Z=0.167, P=0.868). The VAS scores of 2 groups at each time point after operation were significantly lower than those before operation (P<0.05); the VAS score in group A was significantly lower than that in group B (t=−2.317, P=0.024) at 1 day after operation, but there was no significant difference between 2 groups (t=−0.862, P=0.392) at last follow-up. Among the patients with kyphosis, the Cobb angle was significantly decreased at 1 day after operation and last follow-up when compared with preoperative angle (P<0.05); but there was no significant difference between 1 day after operation and last follow-up (P>0.05). There was no significant difference in Cobb angle, loss of angle, and correction rate between 2 groups after operation (P>0.05). The bone graft healed well at last follow-up in 2 groups. There was no significant difference in bone graft fusion rate between 2 groups at 6 months after operation, 1 year after operation, and last follow-up (P>0.05). At last follow-up, all patients cured, and no recurrence occurred.ConclusionIn the anterior surgery of thoracic and lumbar tuberculosis, the application of small incision approach can achieve the similar effectiveness as traditional incision surgery with the advantages of minimally invasive, less complications, and quick recovery.
ObjectiveTo explore the effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation for thoracolumbar tuberculosis. MethodsBetween January 2009 and January 2013, 97 patients with thoracolumbar tuberculosis were treated with posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in 53 cases (group A), and with traditional posterior operation in 44 cases (group B). There was no significant difference in age, sex, disease duration, affected segments, Frankel grade, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), sagittal Cobb angle, visual analogue scale (VAS), and Oswestry disability index (ODI) between 2 groups (P>0.05). The surgery and follow-up results were compared between 2 groups. ResultsThe patients were followed up 24-60 months. All patients achieved intervertebral bone fusion after operation. The bone graft fusion time of groups A and B was (6.79±1.68) months and (6.89±2.00) months respectively, showing no significant difference (t=-0.251, P=0.802). There was no significant difference in operation time, intraoperation blood loss, and postoperative hospitalization time between 2 groups (P>0.05); the postoperative drainage volume of group A was significantly less than that of group B (P<0.05). The CRP and ESR at 1 year and the VAS score at last follow-up were significantly decreased when compared with preoperative values in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). The Cobb angle at 1 week and at last follow-up and ODI at 3 months and at last followup were significantly improved in 2 groups (P<0.05), but there was no significant difference between the time points after operation (P>0.05). At 3 months after operation, the ODI of group A was significantly lower than that of group B (t=-2.185, P=0.027), but no significant difference was found in Cobb angle, Cobb angle loss, and ODI at other time points between 2 groups (P>0.05). At last follow-up, the Frankel classification of nerve function was improved 1-2 grades in 2 groups, showing no significant difference between 2 groups (Z=-0.180, P=0.857). No complication of internal fixation breakage or loosening was observed. ConclusionThe effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation in the treatment of thoracolumbar tuberculosis is satisfactory, with the advantages of less trauma, strong spinal stability, and fast function recovery.
ObjectiveTo investigate the reasons for failure to treat thoracolumbar tuberculosis by anterior internal fixation and its countermeasures. MethodsA total of 485 patients with thoracolumbar spinal tuberculosis underwent anterior focus clearance and fixation from January 2005 to January 2012. Eighteen of them failed with a rate of 3.71%. Screws were pulled out in two patients. Vertebra cutted by screws occurred in three patients. In another three patients, screws dropped into the intervertebral disc. Tuberculosis relapsed in 10 patients (5 accompanied with spinal deformity, 2 with pure malunion, 2 with abscess formation, and 1 with sequestra). Twelve of the patients underwent two-stage posterior pedicle screw internal fixation and anterior focus clearance and autogenous bone grafts fusion. Four were treated by shifting antituberculosis drugs and staying in bed. Two were cured by multiple abscesses puncture and antituberculosis injection. ResultsThese patients were followed up for 15~30 months. Twelve cases of spinal tuberculosis were completely cured and 6 cases of them got clinical cure. However, 3 cases of them had scoliosis deformity followed and 1 had kyphosis. No tuberculosis relapse, cold abscess or sinus formation, or pedicle screw internal fixation failure occurred again. ConclusionAlthough there are many complications of anterior internal fixation for spinal tuberculosis, anterior internal fixation is still a perfect choice if we can make an appropriate choice of operation and strengthen the management after operation.
Objective To investigate the safety of nano-hydroxyapatite/polyamide 66 (n-HA/PA66) bioactive support in bone grafting and fusion for elderly patients with lumbar tuberculosis, and to analyze its effectiveness and advantages by comparing with autologous iliac bone grafting. Methods A retrospective analysis was performed on 48 elderly patients with lumbar tuberculosis who met the selection criteria between January 2017 and January 2020. The patients all underwent one-stage posterior pedicle screw internal fixation combined with anterior lesion removal and bone grafting and fusion, of which 23 cases applied n-HA/PA66 bioactive support+allogeneic bone graft (n-HA/PA66 group) and 25 cases applied autologous iliac bone graft (autologous iliac bone group). There was no significant difference between the two groups in gender, age, bone density, disease duration, lesion segment, and preoperative pain visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and Cobb angle (P>0.05). The operation time, intraoperative blood loss, and postoperative complications, as well as the VAS score, JOA score, American Spinal Injury Association (ASIA) spinal cord injury grading, Cobb angle, and bone fusion were recorded and compared between the two groups. Results The operations were completed successfully in both groups. n-HA/PA66 group had significantly less operation time and intraoperative blood loss than the autologous iliac bone group (P<0.05). All patients were followed up 12-24 months, with an average of 15.7 months. And the difference in follow-up time between the two groups was not significant (P>0.05). Postoperative complications occurred in 3 cases (13%) in the n-HA/PA66 group and 10 cases (40%) in the autologous iliac group, and the difference in the incidence of complications between the two groups was significant (χ2=4.408, P=0.036). The postoperative VAS scores and JOA scores significantly improved when compared with the preoperative scores in both groups (P<0.05), and the difference was significant (P<0.05) between 2 weeks after operation and the last follow-up. The difference in VAS score at 2 weeks after operation was significant between the two groups (P<0.05), and there was no significant difference (P>0.05) at the other time points. At last follow-up, according to the ASIA grading, the effective improvement rate was 86% (18/21) in the n-HA/PA66 group and 90% (18/20) in the autologous iliac group, with no significant difference (χ2=0.176, P=0.675). Imaging review showed that grade Ⅰ bony fusion was obtained in both groups, and the fusion time of bone graft in the n-HA/PA66 group was significantly longer than that in the autologous iliac bone group (P<0.05). There was no significant difference in the Cobb angle at each time point between the two groups (P>0.05). No recurrence of tuberculosis, loosening or fracture of the internal fixator, or displacement of the bone graft was observed during follow-up. Conclusion In elderly patients with lumbar spine tuberculosis, the n-HA/PA66 bioactive support combined with allogeneic bone graft can effectively restore and maintain the fusion segment height and physiological curvature of the lumbar spine, and the fusion rate of bone graft is similar to that of autologous iliac bone, which can achieve better effectiveness.
Objective To investigate the feasibility and effectiveness of robot-assisted posterior minimally invasive access in treatment of thoracolumbar tuberculosis via transforaminal expansion approach. Methods A clinical data of 40 patients with thoracolumbar tuberculosis admitted between January 2017 and May 2022 and met the selection criteria was retrospectively analyzed. Among them, 15 cases were treated with robot-assisted and minimally invasive access via transforaminal expansion approach for lesion removal, bone graft, and internal fixation (robotic group), and 25 cases were treated with traditional transforaminal posterior approach for lesion removal and intervertebral bone grafting (traditional group). There was no significant difference in the baseline data between the two groups (P>0.05) in terms of gender, age, lesion segment, and preoperative American Spinal Injury Association (ASIA) grading, Cobb angle, visual analogue scale (VAS) score, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). The outcome indicators were recorded and compared between the two groups, including operation time, intraoperative bleeding volume, hospital stay, postoperative bedtime, complications, ESR and CRP before operation and at 1 week after operation, the level of serum albumin at 3 days after operation, VAS score and ASIA grading of neurological function before operation and at 6 months after operation, the implant fusion, fusion time, Cobb angle of the lesion, and the loss of Cobb angle observed by X-ray films and CT. The differences of ESR, CRP, and VAS score (change values) between pre- and post-operation were calculated and compared. Results Compared with the traditional group, the operation time and intraoperative bleeding volume in the robotic group were significantly lower and the serum albumin level at 3 days after operation was significantly higher (P<0.05); the postoperative bedtime and the length of hospital stay were also shorter, but the difference was not significant (P>0.05). There were 2 cases of poor incision healing in the traditional group, but no complication occurred in the robotic group, and the difference in the incidence of complication between the two groups was not significant (P>0.05). There were significant differences in the change values of ESR and CRP between the two groups (P<0.05). All Patients were followed up, and the follow-up time was 12-18 months (mean, 13.0 months) in the traditional group and 12-16 months (mean, 13.0 months) in the robotic group. Imaging review showed that all bone grafts fused, and the difference in fusion time between the two groups was not significant (P>0.05). The difference in Cobb angle between the pre- and post-operation in the two groups was significant (P<0.05); and the Cobb angle loss was significant more in the traditional group than in the robotic group (P<0.05). The VAS scores of the two groups significantly decreased at 6 months after operation when compared with those before operation (P<0.05); the difference in the change values of VAS scores between the two groups was not significant (P>0.05). There was no occurrence or aggravation of spinal cord neurological impairment in the two groups after operation. There was a significant difference in ASIA grading between the two groups at 6 months after operation compared to that before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). Conclusion Compared with traditional posterior open operation, the use of robot-assisted minimally invasive access via transforaminal approach for lesion removal and bone grafting internal fixation in the treatment of thoracolumbar tuberculosis can reduce the operation time and intraoperative bleeding, minimizes surgical trauma, and obtain definite effectiveness.
ObjectiveTo investigate the effectiveness of debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion in treatment of thoracolumbar tuberculosis. MethodsBetween January 2008 and October 2010, 22 patients with thoracolumbar tuberculosis were treated by debridement and single-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation and autograft bone fusion, and were given anti-tuberculosis therapy after operation. Of 22 patients, 14 were male and 8 were female with an average age of 42 years (range, 18-66 years). The disease duration was 2-16 months (mean, 6 months). Sixteen double-segment lesions included T7, 8 in 3 cases, T8, 9 in 1 case, T9, 10 in 3 cases, T11, 12 in 2 cases, L1, 2 in 4 cases, and L3, 4 in 3 cases; 6 three-segment lesions included T7-9 in 2 cases, T11-L1 in 1 case, and L2-4 in 3 cases. Preoperative visual analogue scale (VAS) score was 7.50 ± 0.63. According to Frankel classification of America Spinal Injury Association (ASIA), 2 cases were rated as grade B, 4 cases as grade C, 9 cases as grade D, and 7 cases as grade E. ResultsTwenty-two patients were followed up 15-36 months (mean, 25.2 months). Wound infection occurred in 1 case and was cured after corresponding treatment; incision healed by first intention in other patients. No loosening or breakage of internal fixator was found; the patients had no deteriorations in spinal cord injury or cerebrospinal fluid leakage. X-ray films and CT showed obvious bone fusion in the intervertebral space. The time of bone fusion was 3-6 months (mean, 5.2 months). The erythrocyte sedimentation rate after operation was significantly lower than that before operation (P lt; 0.05). The VAS scores were significantly improved to 2.90 ± 1.00 at 2 weeks after operation and 2.60 ± 0.81 at last follow-up (P lt; 0.05). At last follow-up, nerve function was significantly improved. According to Frankel classification, 2 cases were rated as grade C, 5 cases as grade D, and 15 cases as grade E. ConclusionSingle-incision vertebral screw-rod fixation combined with pedicle screw-rod fixation for thoracolumbar tuberculosis is a stable and minimally invasive method. However, the long-term effectiveness need further follow-up.
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 L1, 2 in 5 patients, L2, 3 in 6 patients, L3, 4 in 3 patients, and L4, 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.