Treatment of Lumbar Tuberculosis by Mini-Open Anterior Approach Focal Cleaning Combined with Posterior Internal Fixation

Ying, Xiaozhang; Shi, Shiyuan; Zheng, Qi; Shen, Jian Ren; Zhu, Bo; Jin, Yanghui; Wang, Yifang

doi:10.12659/msm.902458

Cited by 5 publications

(6 citation statements)

References 29 publications

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“…For upper lumbar and midlumbar spine, a few authors have advocated for the anterior focal cleaning and strut graft combined with posterior fixation of the disease segment. 16,49 Our experience of patients with lumbar disease supports the view because it allows for good postoperative rehabilitation of patients. Hirakawa et al 50 reported that the lesion can be reached directly and decompressing the spinal cord effectively.…”

Section: Lumbar/lumbosacral Tbmentioning

confidence: 61%

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Debnath

McConnell

Kumar³

2021

Int J Spine Surg

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Background: A combined anterior decompression and stabilization followed by posterior instrumented fusion promotes fusion of the affected segment of spine and prevents further progression of deformity. The objective of this study is to report on outcome of patients with tuberculous spondylitis, progressive neurologic deficit, and kyphotic deformity who underwent single-stage anterior corpectomy and fusion and posterior decompression with instrumented fusion.Methods: A total of 49 patients (29 males, 20 females) with varying grades of neurological deficit due to tuberculosis of the spine (thoracic, thoracolumbar, and lumbar) were included in this prospective study. The diagnosis of tubercular infection was established after clinical, hematological, radiological, and histological specimens taken at surgery. All were treated with combined anterior and posterior decompression, debridement, and stabilization with direct autologous bone grafting or wrapped bone graft in mesh or expandable cages. Neurological status and visual analog scale (VAS) pain score were recorded at each visit. X-rays, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and liver function were evaluated at 3, 6, and 12 months after surgery and then once a year thereafter. Results were analyzed in terms of neurological recovery (Frankel grade), bony union time, and correction of kyphotic deformity.Results: The mean age was 37.8 years (range, 2-65 years). Mean preoperative VAS scores improved from 5.6 to 1.5. The average ESR and CRP returned to normal within 6 months in all patients. The mean time to fusion was 8.4 months for the whole group. The neurological deficit in 42 of 49 patients had excellent or good clinical outcome (P , .0001). A total of 10 of 17 patients improved from Frankel A and B to Frankel E (normal activity). Three patients each in the thoracic and thoracolumbar groups improved to Frankel D. Radiological measurements showed the mean kyphotic correction was 61%, 66%, and 67% in the thoracic, thoracolumbar, and lumbar/lumbosacral spine, respectively.Conclusions: Combined single-stage anterior decompression and stabilization followed by posterior instrumented fusion is safe and effective in the treatment of tuberculous spondylitis with neurological deficit in the thoracic and lumbar spine. This procedure helps to correct and maintain the deformity, abscess clearance, spinal-cord decompression, and pain relief as well as return to normal motor function. Bony fusion prevents further progression of deformity.

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Section: Lumbar/lumbosacral Tbmentioning

confidence: 61%

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Debnath

McConnell

Kumar³

2021

Int J Spine Surg

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“…However, the candidates for this procedure were adult patients with mild anterior column destruction due to the concern of progressive kyphosis. Ying et al [25] described mini-open anterior approach focal clearance combined with posterior internal fixation for lumbar tuberculosis. The anatomical challenge within a small incision and the disturbance to the peritoneum were the limitations of this technique.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive far lateral debridement combined with posterior instrumentation for thoracic and lumbar tuberculosis without severe kyphosis

Wei

Zhang

et al. 2020

J Orthop Surg Res

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Background: Anti-tuberculous therapy (ATT) alone cannot easily cure spine tuberculosis (STB) though it is the most essential treatment. Many studies have confirmed the efficacy of the surgical treatment of STB through anterior, anterolateral, posterior debridement, and intervertebral fusion or combined with internal fixation. However, the conventional surgical approach requires extensive exposure of the affected areas with high rates of morbidity and mortality. Recently, minimally invasive surgery has come into use to reduce iatrogenic trauma and relevant complications. Here, we introduced a novel technique for the treatment of thoracic and lumbar spine tuberculosis: minimally invasive far lateral debridement and posterior instrumentation (MI-FLDPI). In this study, we evaluated the technical feasibility, the clinical outcomes, and the postoperative complications. Methods: We did a prospective, non-randomized study on this new technique. Twenty three patients (13 males) with thoracic or lumbar spine tuberculosis who underwent minimally invasive far lateral debridement and posterior instrumentation were included in the study. The preoperative comorbidities, operation duration, intra-operative hemorrhage, Cobb's angles, and postoperative complications were recorded and analyzed. Clinical outcomes were evaluated by Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological recovery, and eradication of tuberculosis. Radiological outcomes were evaluated by changes in Cobb's angle and fusion status of the affected segments. Results: The patients were followed for an average of 19 months (ranging from 12 to 36 months). At the final follow-up, CRP and ESR of all patients were normal. The VAS and ODI were significantly improved compared with preoperative values (P < 0.05). No evident progression of the kyphotic deformity was found after surgery. Twenty two patients showed spontaneous peripheral interbody fusion 1 year after surgery. There were no failure of the instrumentation even though a young female with drug-resistant tuberculosis showed no sign of interbody fusion at the third year follow-up. All the patients with preoperative neurological deficit showed complete recovery at the final follow-up.

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“…For the spinal tuberculosis that requires surgery, the currently commonly used surgical methods include: anterior lesion removal and bone grafting,fusion internal xation;posterior lesion removal,bone graft fusion and internal xation;and combined anterior and posterior surgery,etc [7,8].However,the abovementioned surgical methods have disadvantages such as large trauma,excessive bleeding,and many postoperative complications [9,10].Minimally invasive treatment of spinal diseases,including spinal tuberculosis,is the development direction of spinal surgery, which is conducive to the rapid recovery of patients after surgery and early return to society [11].Researchers have tried to use different minimally invasive methods to treat lumbar spine tuberculosis.Ying et al [12] reported that anterior small incisions combined with posterior internal xation were used to treat lumbar spine tuberculosis.Wang et al [13] reported that the extreme lateral channel combined with percutaneous posterior pedicle screw xation to treat similar patients.Both have achieved good clinical results. However, none of the above methods are operated through the anatomical gap, and the trauma is still large.…”

Section: Discussionmentioning

confidence: 99%

A comparative study of oblique lumbar interbody fusion combined posterior percutaneous internal fixation and the anterior-posterior combined surgery in the treatment of single-segment lumbar tuberculosis

Liu¹,

Huang²,

Yuan³

et al. 2020

Preprint

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Objectives:To study the clinical effect of OLIF channel combined with posterior percutaneous pedicle screw fixation in the treatment of single-segment lumbar tuberculosis.Methods:Using a retrospective controlled study, patients who were diagnosed with single-segment lumbar tuberculosis were divided into the minimal invasive group(the anterior debridement and fusion by OLIF technique combined percutaneous pedicle screw group) and the open group(the anterior-posterior combined surgery group) according to different surgical methods from July 2016 to October 2018,then the surgical-related parameters and surgical effects of the two groups of patients were compared.Results:The minimal invasive group was superior to the open group in operation time, abdominal incision length,intraoperative blood loss,postoperative drainage, and CPK,the differences were statistically significant (P<0.05);The VAS scores of low back pain after 3 days,3mounths and last follow-up of surgery was significantly lower than before surgery in both goups (P<0.05), which in the minimal invasive group was significantly lower than those in the open group at 3days after surgery （P<0.05）,but no significance in other time point(P＞0.05).The ODI index, ESR, CRP before operation, 3 months and the last follow-up after surgery were not statistically different between two groups(P＞0.05),and significant difference in the group(P<0.05). Postoperative lumbar lordosis increased significantly in the two groups after operation, and there was no statistical difference between the groups at each time point(P＞0.05).Conclusion:The clinical effect of OLIF channel combined with posterior percutaneous pedicle screw fixation in the treatment of single-segment lumbar tuberculosis is not different from the anterior-posterior combined surgery, but the trauma is smaller and the recovery is faster in the former, which has certain advantages in clinic.

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Treatment of Lumbar Tuberculosis by Mini-Open Anterior Approach Focal Cleaning Combined with Posterior Internal Fixation

Cited by 5 publications

References 29 publications

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Single-Stage Combined Anterior Corpectomy and Posterior Instrumented Fusion in Tuberculous Spondylitis With Varying Degrees of Neurological Deficit

Minimally invasive far lateral debridement combined with posterior instrumentation for thoracic and lumbar tuberculosis without severe kyphosis

A comparative study of oblique lumbar interbody fusion combined posterior percutaneous internal fixation and the anterior-posterior combined surgery in the treatment of single-segment lumbar tuberculosis

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