Five-year outcomes of posterior affected-vertebrae fixation in lumbar tuberculosis patients

Abstract

BackgroundPosterior instrumentation after deformity correction is an important method for reconstruction of spinal stability in the management of lumbar tuberculosis (TB). However, the commonly used methods include both long- and short-segment fixation of normal motor units. There has been no report regarding affected-vertebrae fixation of lumbar TB.MethodsData from 135 patients with lumbar TB who underwent posterior instrumentation and either affected-vertebrae fixation or short-segment fixation using a combined posterior and anterior approach were retrospectively reviewed. Among these patients, 71 cases were treated with affected-vertebrae fixation, and 64 cases were treated with short-segment fixation. Debridement, bone grafting, deformity correction, and decompression were performed within all affected segments. Operative times, intra-operative blood loss, TB cure rates, bone graft fusion rates, degree of deformity correction, neurological function, pain recovery, and complications were analyzed.ResultsComparing affected-vertebrae fixation vs. short-segment fixation groups, respectively, the number of the affected segments was 107 vs. 98; average number of affected segments was 1.51 vs. 1.53; total number of fixed segments was 107 vs. 226; average number of fixed segments was 1.51 vs. 3.53; average blood loss was 726.2 ml vs. 948.5 ml; average operative time was 210.4 min vs. 270.3 min; and average hospitalization costs were 29,000 RMB vs. 42,000 RMB (all p values < 0.05). In the affected-vertebrae fixation vs. short-segment fixation groups, respectively, TB cure rates were 82.61% vs. 84.62% at 6 months after operation and 97.83% vs. 97.44% at 5 years after operation; bone fusion rates were 86.96% vs. 87.18% at 6 months after operation and 97.83% vs. 97.66% at 5 years after operation; average number of degrees of Cobb’s angle correction were 13.1° vs. 13.7°; average correction losses were 1.9° vs. 1.4°; and complication rates were 12.04% vs. 12.97% (all p values > 0.05).ConclusionUnder strict surgical indications, posterior instrumentation on affected-vertebrae is a safe, effective, and feasible fixation method in the treatment of lumber TB.

Mono-segment fixation method versus short-segment fixation methods, in treatment of mono-segmental lumbar tuberculosis; using titanium mesh cage with interbody fusion retrospective case-control study.

“…Also, the incision length in mono-segment fixation was relatively shorter compared to that of short-segment fixation. Our results are similar to those reported in the literature by Liang et al (18), and Liu et al (32). Nevertheless, there was no substantial difference between the two groups with respect to the number of hospital stays, VAS, ODI, neurological recovery as assessed by Frankel impairment scale, ESR, CRP and fusion time.…”

“…These indications are the same as previously reported by Liang et al (18) as follows: (1) Both endplates of the diseased vertebrae shall be intact to provide a secure host bed for graft fusion. (2) kyphosis deformity should be < 60 0 .…”

“…The purpose of spinal surgery involves the eradication of the lesion, decompression of the nerves, restoration of spinal stability and correction of spinal deformity (14)(15)(16)(17). currently, short-and long-segment fixation methods are commonly used during the surgical treatment of spinal TB (18,19).…”

One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adult patients following minimum 5-year follow-up

“…Previous studies have shown that the range of xation for mono-segmental lumbar and lumbosacral spinal TB in adults involves one to multiple normal motion units above and below the lesion via posterior debridement, decompression and instrumentation. Although multisegment xation provides strong temporary stability, it sacri ces the motion of the xed segments and accelerates degeneration of adjacent segments [21,22]. Since the lumbar region requires greater mobility than the rest of vertebral column, adopting a surgical approach with minimally invasion and less damage to the vertebral function is the major goal for treating mono-segmental lumbar and lumbosacral spinal TB.…”

How to select the fusion and fixation range of thoracolumbar and lumbar tuberculosis: A retrospective clinical study

“…Besides, partial or total normal intervertebral space or/and posterolateral were fused with diseased intervertebral fusion and xed range [4; 5]. Although the xation and fusion methods above can meet the biomechanics requirements of spinal stiffness, they sacri ce the normal motor units of the spine, leading to the degeneration of adjacent segments and the occurrence of chronic lower back pain [6]. It is urgent to consider whether the xed range can be reduced, and the mechanical strength of the spine can be fully reconstructed.…”