EFFECTIVENESS OF POSTERIOR UNILATERAL TRANSPEDICULAR DEBRIDEMENT, BONE GRAFT FUSION, AND PEDICLE SCREW FIXATION FOR THORACOLUMBAL TUBERCULOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WUPeng ,  OUYunsheng , LIUDelong , ZHUYong , ZHAOZenghui , JIANGDianming

Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, P. R. China;

Corresponding author：

OUYunsheng, Email: ouyunsheng2001@163.com

Keywords：

Thoracolumbar tuberculosis; Unilateral pedicle bone graft; Internal fixation; Posterior operation

DOI：

10.7507/1002-1892.20150273

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Objective To explore the effectiveness of posterior unilateral transpedicular debridement, bone graft fusion, and pedicle screw fixation for thoracolumbar tuberculosis. Methods Between 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. Results The 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. Conclusion The 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.

Citation： WUPeng, OUYunsheng, LIUDelong, ZHUYong, ZHAOZenghui, JIANGDianming. EFFECTIVENESS OF POSTERIOR UNILATERAL TRANSPEDICULAR DEBRIDEMENT, BONE GRAFT FUSION, AND PEDICLE SCREW FIXATION FOR THORACOLUMBAL TUBERCULOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1259-1264. doi: 10.7507/1002-1892.20150273 Copy

1.	Moon MS. Development in the management of tuberculosis of the spine. Curr Orthop, 2006, 20(2):132-140.
2.	Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg (Am), 1989, 71(9):1314-1323.
3.	Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debirdment, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12):1677-1683.
4.	Gong K, Wang Z, Luo Z. Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. Arch Orthop Trauma Surg, 2011, 131(2): 217-223.
5.	Lee JS, Moon KP, Kim SJ, et al. Posterior lumbar interbody fusion and posterior instrumentation in the surgical management of lumbar tuberculous spondylitis. J Bone Joint Surg (Br), 2007, 89(2): 210-214.
6.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do the work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine, 1995, 20(12):1410-1418.
7.	Chow JH, Chan CC. Validation of the Chinese version of the Oswestry Disability Index. Work, 2005, 25(4):307-314.
8.	Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg (Br), 2008, 90(11):1477-1481.
9.	Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15):E302-308.
10.	Flamme CH, Hurschler C, Heymann C, et al. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine (Phila Pa 1976), 2005, 30(13):E352-362.
11.	Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine. Spinal Cord, 2001, 39(8):429-436.
12.	Li L, Xu J, Ma Y, et al. Surgical strategy and management outcomes for adjacent multisegmental spinal tuberculosis. Spine (Phila Pa 1976), 2014, 39(1):E40-48.
13.	Liu P, Sun M, Li S, et al. A retrospective controlled study of three different perative approaches for the treatment of thoracic and lumbar spinaltuberculosis:three years of follow-up. Clin Neurol Neurosurg, 2015, 128:25-34.
14.	Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
15.	马远征. 关于脊柱结核病灶清除术的入路问题. 中国脊柱脊髓杂志, 2012, 22(9):774.
16.	崔旭, 马远征, 陈兴, 等. 脊柱结核前后路不同术式的选择及其疗效. 中国脊柱脊髓杂志, 2011, 21(10):807-811.
17.	Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic dusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

1. Moon MS. Development in the management of tuberculosis of the spine. Curr Orthop, 2006, 20(2):132-140.
2. Rajasekaran S, Soundarapandian S. Progression of kyphosis in tuberculosis of the spine treated by anterior arthrodesis. J Bone Joint Surg (Am), 1989, 71(9):1314-1323.
3. Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debirdment, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12):1677-1683.
4. Gong K, Wang Z, Luo Z. Single-stage posterior debridement and transforaminal lumbar interbody fusion with autogenous bone grafting and posterior instrumentation in the surgical management of lumbar tuberculosis. Arch Orthop Trauma Surg, 2011, 131(2): 217-223.
5. Lee JS, Moon KP, Kim SJ, et al. Posterior lumbar interbody fusion and posterior instrumentation in the surgical management of lumbar tuberculous spondylitis. J Bone Joint Surg (Br), 2007, 89(2): 210-214.
6. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do the work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine, 1995, 20(12):1410-1418.
7. Chow JH, Chan CC. Validation of the Chinese version of the Oswestry Disability Index. Work, 2005, 25(4):307-314.
8. Jain AK, Dhammi IK, Prashad B, et al. Simultaneous anterior decompression and posterior instrumentation of the tuberculous spine using an anterolateral extrapleural approach. J Bone Joint Surg (Br), 2008, 90(11):1477-1481.
9. Fukuta S, Miyamoto K, Masuda T, et al. Two-stage (posterior and anterior) surgical treatment using posterior spinal instrumentation for pyogenic and tuberculotic spondylitis. Spine (Phila Pa 1976), 2003, 28(15):E302-308.
10. Flamme CH, Hurschler C, Heymann C, et al. Comparative biomechanical testing of anterior and posterior stabilization procedures. Spine (Phila Pa 1976), 2005, 30(13):E352-362.
11. Laheri VJ, Badhe NP, Dewnany GT. Single stage decompression, anterior interbody fusion and posterior instrumentation for tuberculous kyphosis of thedorso-lumbar spine. Spinal Cord, 2001, 39(8):429-436.
12. Li L, Xu J, Ma Y, et al. Surgical strategy and management outcomes for adjacent multisegmental spinal tuberculosis. Spine (Phila Pa 1976), 2014, 39(1):E40-48.
13. Liu P, Sun M, Li S, et al. A retrospective controlled study of three different perative approaches for the treatment of thoracic and lumbar spinaltuberculosis:three years of follow-up. Clin Neurol Neurosurg, 2015, 128:25-34.
14. Wang X, Pang X, Wu P, et al. One-stage anterior debridement, bone grafting and posterior instrumentation vs. single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic and lumbar spinal tuberculosis. Eur Spine J, 2014, 23(4): 830-837.
15. 马远征. 关于脊柱结核病灶清除术的入路问题. 中国脊柱脊髓杂志, 2012, 22(9):774.
16. 崔旭, 马远征, 陈兴, 等. 脊柱结核前后路不同术式的选择及其疗效. 中国脊柱脊髓杂志, 2011, 21(10):807-811.
17. Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic dusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

Chinese Journal of Reparative and Reconstructive Surgery

EFFECTIVENESS OF POSTERIOR UNILATERAL TRANSPEDICULAR DEBRIDEMENT, BONE GRAFT FUSION, AND PEDICLE SCREW FIXATION FOR THORACOLUMBAL TUBERCULOSIS

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