Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only

Wang, Yuxiang; Zhang, Hongqi; Li, Min; Tang, Mingxing; Guo, Chaofeng; Deng, Ang; Gao, Qile; Wu, Jianhuang; Liu, Jinyang

doi:10.1016/j.injury.2016.12.025

Cited by 39 publications

(37 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The main indications for surgery by an anterior combined with posterior approach were the following: severe vertebral body damage or collapse; involvement of at least 3 vertebral bodies; spinal instability after debridement; invasion of the spinal canal by abscess or sequestrum, causing spinal cord compression; severe kyphosis that would be difficult to correct using an anterior or posterior approach, accompanied by a massive paravertebral, psoatic, or migrating abscess; skipped multi-segmental spinal tuberculosis; and severe spinal instability [12]. The main indications for surgery by a posterior-only approach were the following: no more than 3 adjacent vertebral segments requiring surgery; normal bone for tunnel fixation; a history of surgery by an anterior approach, which may have led to unclear anterior anatomical structures; and the ability to complete debridement through a posterior-only approach [13, 14]. The three surgical approaches were performed as standard operating procedures.…”

Section: Methodsmentioning

confidence: 99%

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Tang

Yang

et al. 2019

J Orthop Surg Res

View full text Add to dashboard Cite

Background The purpose of this multicentre, retrospective study was to evaluate the safety and efficacy of different surgical approaches for treating thoracolumbar tuberculosis. Methods This study reviewed 132 patients with thoracolumbar tuberculosis in six institutions between January 1999 and January 2015 surgically treated by an anterior-only approach ( n = 22, group A), an anterior combined with posterior approach ( n = 79, group B), and a posterior-only approach ( n = 31, group C). All patients were treated with standard antituberculosis drugs pre- and postoperatively and were followed regularly after surgery. Clinical symptoms, nerve function, and the erythrocyte sedimentation rate were observed, and kyphosis correction and bone fusion were evaluated by X-ray or computed tomography. Results At the last follow-up, all patients had achieved bone fusion, relief from pain, and neurological recovery. The Cobb angle was improved; however, the Cobb angle showed a degree of loss at the final follow-up after all three surgical approaches. Further comparisons revealed a difference in angle loss at the final follow-up among the three groups; groups B and C were superior to group A in maintenance of the correction. The posterior-only approach was characterized by a shorter operative time and reduced blood loss. Conclusions Surgery by a posterior-only approach is superior to that by an anterior-only approach and anterior combined with posterior approach in terms of permanent kyphosis correction and spinal stability maintenance. Therefore, we recommend surgery by a posterior-only approach as the optimized treatment for thoracolumbar tuberculosis if the indications for this treatment are met.

show abstract

Section: Methodsmentioning

confidence: 99%

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Tang

Yang

et al. 2019

J Orthop Surg Res

View full text Add to dashboard Cite

show abstract

“…Spinal tuberculosis is a major cause of paraplegia in developing countries, and older people are at high risk of contracting the disease. 11 Given that the elderly have many complications, such as poor physical tolerance and osteoporosis, it is particularly di cult to deal with senile spinal tuberculosis in clinical setting. Elderly patients with spinal tuberculosis usually have the following characteristics: owing to the existence of low back pain or neurological dysfunction, patients prefer to stay in bed, and reduced activity may aggravate the degree of osteoporosis, forming a vicious circle 12 ; the nutritional status of elderly patients is sometimes poor, and most patients are complicated with hypoproteinemia and anemia, especially those with spinal tuberculosis.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Yang¹,

He²,

Wei³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: to evaluate the safety and efficacy of Polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis.Methods: 34 elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis underwent PASF after anterior or posterior debridement and bone grafting in our hospital from January 2010 to January 2012. The follow-ups were performed at 1, 3, 6, and 12 months postoperatively and then annually thereafter. The segmental cobb angle was measured to evaluate kyphosis improvement. The laboratory examination including ESR and CRP was also monitored. The pre- and postoperative VAS score, ODI score, and neurological function of ASIA scale were also recorded.Results: The included 21 patients completed the operation successfully. In all patients with neurological dysfunction, the ASIA grade improved by at least 1 grade. One month postoperatively, the VAS score, ODI, segmental Cobb angle, ESR, and CRP were significantly improved compared with those preoperatively (P<0.05); there was no significant difference in the values at 1 month postoperatively and last follow-up (P＞0.05). There were no complications such as implant failure, proximal junctional kyphosis, or recurrence of tuberculosis at the minimum 5-year follow-up. Conclusion: For elderly patients with thoracolumbar spinal tuberculosis complicated with severe osteoporosis, after anterior or posterior debridement and bone grafting, together with postoperative systematic anti-tuberculosis and anti-osteoporosis treatments, PASF is safe and effective without catastrophic complications such as intraspinal cement leakage. During the 5-year follow-up, there was no tuberculosis recurrence or implant failure.

show abstract

“…Moreover, inserting the titanium mesh is difficult. Sometimes, the implanted bed in the lesioned area must be expanded, slightly compromising spinal stability and significantly increasing the blood loss associated with bone grafting and the time required for grafting [5,19].…”

Section: Discussionmentioning

confidence: 99%

Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis

Tang

Gui

et al. 2019

J Orthop Surg Res

View full text Add to dashboard Cite

Background There was a controversy about bone grafting of spinal tuberculosis treatment. The aim of this study was to compare the clinical efficacy of a new bone grafting method—transverse bone grafting (TBG)—with iliac bone grafting (IBG) and titanium mesh grafting (TMG) in the treatment of single-segment thoracic spinal tuberculosis. Material and methods TBG was undertaken in 30 patients (group A), IBG was carried out in 28 patients (group B), and TMG was performed in 36 patients (group C). The operative time, intraoperative blood loss, postoperative drainage amount, postoperative complications, length of hospital stay, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score for back pain, Oswestry dysfunction index (ODI), intervertebral height, and time to bone graft fusion were compared. Changes in the Cobb angle of kyphosis, intervertebral height, and loss to the final follow-up were measured. Neurological function recovery was evaluated according to the criteria of the American Spinal Injury Association (ASIA). Results The operative times in group A was significantly shorter than those in groups B and C ( P AB = 0.036, P AC = 0.005, P BC = 0.901). The hospital stay in group A was significantly shorter than that in groups B and C ( P AB = 0.022, P AC = 0.031, P BC = 0.424). The intraoperative blood loss in group A was significantly less than that in groups B and C ( P AB = 0.045, P AC = 0.004, P BC = 0.586). The VAS score, ODI, ESR level, CRP level, Cobb angle of kyphosis, and intervertebral height of the affected segment were significantly improved compared with those before surgery ( P < 0.05). Conclusion For the treatment of single-segment thoracic spinal tuberculosis, the new interbody fusion technique using transverse process bone grafting is a safe, reliable, effective, and ideal bone grafting method.

show abstract

Debridement, interbody graft using titanium mesh cages, posterior instrumentation and fusion in the surgical treatment of multilevel noncontiguous spinal tuberculosis in elderly patients via a posterior-only

Cited by 39 publications

References 28 publications

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Surgical treatment of thoracolumbar spinal tuberculosis—a multicentre, retrospective, case-control study

Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis

Contact Info

Product

Resources

About