One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children

Hu, Xiongke; Zhang, Hongqi; Yin, Xingtian; Yong, Chen; Yu, Haoyong; Zhou, Zhenhai

doi:10.1007/s00381-015-2948-3

Cited by 17 publications

(15 citation statements)

References 18 publications

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“…The kyphotic angle, a major indicator of deformity correction and spinal stability reconstruction, was improved significantly after surgery (−4.61° ± 7.31° vs 24.00° ± 13.15°, Z = −4.34, P < .01); the mean deformity correction was 28.61° ± 8.43°, and the mean correction loss at the last follow-up was 1.50° ± 0.90°. Wang et al [17] and He et al [18] reported that the correction angle of lumbar TB in children treated by short-segment fixation and long-segment fixation was 24.2° and 25.2°, the correction loss was 1.2° and 1.1°, respectively; these values were similar to the results of intervertebral surgery in the present study. At the last follow-up, there was no imbalance between anterior and posterior vertebral columns in the present study.…”

Section: Discussionsupporting

confidence: 88%

The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children

Liang

Wang

et al. 2019

Medicine

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During the operation of treating lumbar tuberculosis in children, a long-segment or short-segment fixation, and fusion method were usually applied, which would adversely affect the function of normal motion unit. And so, we have been focusing on how we can shorten the range of fixation and fusion using intervertebral surgery. The objective of this retrospective study is to investigate the clinical outcome of intervertebral surgery, in the treatment of lumbar tuberculosis in children.From June 2003 to June 2013, 18 children with lumbar tuberculosis underwent intervertebral surgery, using a combined posterior and anterior approach, in our hospital. The surgical treatments included posterior pedicle screw fixation of affected vertebrae and posterolateral bone grafting, anterior debridement, compression, and strut bone grafting. Indicators such as preoperative and postoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) levels, neurological function, visual analog scale (VAS) score, kyphotic Cobb angle, complications, healing of lesions, bone graft healing, and recurrence were statistically analyzed.The mean follow-up time was 86.5 months (range, 62–120 months). Three months after the operation, all patients’ ESR and CRP levels decreased to normal, and both the American Spinal Injury Association neurological function scores and VAS scores improved. Successful bone graft healing was achieved, with lesions completely healed at 6 months after surgery, and no recurrence occurred. The preoperative kyphotic was 24.00° ± 13.15° (range −10°–39°), which decreased to −4.61° ± 7.31° (range −19°–10°) postoperative (Z = −4.34, P < .01); the mean deformity correction angle was 28.61° ± 8.43° (range 9°–43°). There was no significant difference between the kyphotic angle measured immediately after surgery at (−4.61° ± 7.31°) and the kyphotic angle measured at 5-year follow-up at (−3.11° ± 7.56°). The mean loss of correction was 1.50° ± 0.90°.Intervertebral surgery using a combined posterior and anterior approach is an effective and safe method for the treatment of lumbar tuberculosis in children. It can also preserve the function of normal motor segments to the maximum extent.

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Section: Discussionsupporting

confidence: 88%

The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children

Liang

Wang

et al. 2019

Medicine

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“…However, this surgical strategy greatly increases the operative time, blood loss volume, surgical trauma, and incidence of perioperative complications [5–7]. In recent years, it has been reported that in cases of progressive single-segment spinal tuberculosis, surgery by a posterior approach can achieve complete debridement, decompression, bone fusion, and internal fixation and can effectively correct spinal kyphosis, which has the advantages of mild trauma, few perioperative complications, low cost, and short recovery time[8, 9]. To analyse the clinical efficacy of different surgical methods for the treatment of thoracolumbar tuberculosis, we retrospectively analysed 132 patients with thoracolumbar tuberculosis treated in 6 hospitals.…”

Section: Introductionmentioning

confidence: 99%

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

Tang

Yang

et al. 2019

J Orthop Surg Res

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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.

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“…Spinal TB in children, whose brous rings and endplate cartilage are rich both in blood and lymphatic vessels, are more likely to propagate to different spinal segments than that in adult-aged patients [9]. Furthermore, spinal cords are nourished through smaller epidural spaces and blood vessels in pediatric-aged patients than in comparison to adults, resulting spinal TB a ictions in children with consequential higher related risks of neurological damage [10]. In addition, unbalance in the dynamics of spinal growth between anterior-middle columns, the most frequently involved site of spinal TB, and posterior columns, or heterogeneous types of injuries related to epiphysis of diseased vertebral bodies, makes pediatric-aged patients more prone to scoliosis or kyphosis compared to adult-aged patients.…”

Section: Discussionmentioning

confidence: 99%

Clinical Effectiveness of Treatment of Children Afflicted by Lumbar Tuberculosis With Posterior-only Approach Using Poly-ether-ether-ketone Cage Combined With Single-segment Instrumentation

Zhang¹,

Chen²,

Wang³

et al. 2021

Preprint

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Background: We sought to investigate the clinical outcomes of posterior-only approach using poly-ether-ether-ketone (PEEK) cage combined with single-segment instrumentation in the treatment of lumbar tuberculosis in children.Methods: Between February 2008 and August 2017 in our hospital, 18 children with single-segment lumbar tuberculosis were enrolled in this study. Children were treated by a posterior-only approach using PEEK cage combined with single-segment instrumentation. Medical records and radiographs were retrospectively analyzed. Visual analogue scores (VAS) were used to evaluate measures of quality of daily life. Criteria defined from the American Spinal Injury Association (ASIA) were used to evaluate measures of neurological function.Results: Mean follow-up time was 54.6 ± 12.1 months (39–84 months). No severe complications were noted to have occurred. Measures indicated there was satisfactory bone fusion for observations for all patients. Mean Cobb angles were significantly decreased from the mean preoperative angle (19.8° ± 13.1°) to those both postoperatively (-4.9° ± 7.6°) and at final follow-up (-3.5° ± 7.3°) (both P < 0.05), with a mean angle loss of 1.7° ± 0.9°. Th erythrocyte sedimentation rate (ESR) returned to normal levels for all patients within 3 months postoperatively. All patients had significant postoperative improvement in respect to neurological performance and VAS scores.Conclusions: The posterior-only approach using PEEK cage combined with single-segment instrumentation was found to be an effective and feasible treatment option for children with lumbar tuberculosis. Such procedures can likely be used to help patients by facilitating reconstruction of spinal stability, and increasing retainment of lumbar mobility in conjunction with reduced invasiveness compared to counterpart treatments.

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One-stage posterior focus debridement, fusion, and instrumentation in the surgical treatment of lumbar spinal tuberculosis with kyphosis in children

Abstract: The outcomes of follow-up showed that one-stage posterior focus debridement, fusion, and instrumentation can be an effective treatment method for the lumbar spinal tuberculosis with kyphosis in children.

Cited by 17 publications

References 18 publications

The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children

The outcome of intervertebral surgery in the treatment of lumbar tuberculosis in children

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

Clinical Effectiveness of Treatment of Children Afflicted by Lumbar Tuberculosis With Posterior-only Approach Using Poly-ether-ether-ketone Cage Combined With Single-segment Instrumentation

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