One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENLin , QINJianpu , AOJun , LIAOWenbo ,  CAIYuqiang

Department of Spinal Surgery, Affiliated Hospital of Zunyi Medical College, Zunyi Guizhou, 563003, P. R. China;

Corresponding author：

CAIYuqiang, Email: caihuofu@sina.com

Keywords：

Lumbosacral spinal tuberculosis; Facet joint; Posterior operation; Debridement; Internal fixation

DOI：

10.7507/1002-1892.20160173

Video：

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Objective To evaluate the feasibility and effectiveness of one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. Methods Between January 2010 and December 2014, 32 cases of lumbosacral spinal tuberculosis (L₄-S₁) were treated by one-stage posterior retaining part facet joint in laminectomy, bone graft and debridement combined with short segmental pedicle screw fixation. There were 20 males and 12 females, aged 17-62 years (mean, 43 years). The disease duration was 12-48 months (mean, 18 months). The involved segments included L₅, S₁ level in 19 cases and L_{4, 5} level in 13 cases. The effectiveness was evaluated by Oswestry disability index (ODI) and imaging parameters (lumbar-sacral angle correction and Bridwell classification and CT fusion criteria) after operation. Results The operation was successfully completed in all patients; the average operation time was 180 minutes, and the average intraoperative blood loss was 400 mL. All cases were followed up 12 to 67 months (mean, 15.6 months). At last follow-up, common toxic symptom of tuberculosis disappeared, and no internal fixation failure occurred. Neurological function was recovered to normal in 7 patients with neurological symptoms, and American Spinal Injury Association (ASIA) scale was improved to grade E from grade C (2 cases) and grade D (5 cases) before operation. At 1 year and last follow-up, the ODI scores were significantly improved when compared with preoperative score (P < 0.05), but no significant difference was found between at 1 year and last follow-up (P>0.05). The lumbarsacral angle was significantly increased at 7 days, 1 year and last follow-up when compared with preoperative one (P < 0.05), but there was no significant difference between different time points after operation (P>0.05). The bone graft fusion time was 9-24 months (mean, 12 months). At 1 year after operation and last follow-up, X-ray Bridwill bone fusion rates were 87.50% (28/32) and 93.75% (30/32) respectively, and CT fusion rates were 87.50% (28/32) and 90.63% (29/32) respectively; and there was significant difference in interbody fusion between at 1 year and last follow-up (P < 0.05). Drug resistance was observed in 4 cases; Bridwill gradeⅢand gradeⅣfusion was shown in 3 cases and 1 case after adjusting the anti-tuberculosis scheme after 1 year. Conclusion One-stage posterior retaining part facet joint in laminectomy and debridement can effectively clear the tuberculose focus, intervertebral bone graft combined with short segment pedicle screw fixation can maintain postoperative spinal reliable stability and get satisfactory bone fusion rate, so it is an effective method for the treatment of lumbosacral tuberculosis.

Citation： CHENLin, QINJianpu, AOJun, LIAOWenbo, CAIYuqiang. One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis. Chinese Journal of Reparative and Reconstructive Surgery, 2016, 30(7): 849-854. doi: 10.7507/1002-1892.20160173 Copy

1.	吴在德, 吴肇汉.外科学. 6版.北京:人民卫生出版社, 2005: 898.
2.	赵玉沛, 陈孝平.外科学. 3版.北京:人民卫生出版社, 2015: 991.
3.	蔡和, 汤泳强.脊柱不稳固X线表现及测量方法研究(附73例分析).放射学实践, 2000, 15(5): 362-364.
4.	Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
5.	Nakshima H, Yukawa Y, Ito K, et al. Extension CT scan: its suitability for fusion after posterior lumbar interbody fusion. Eur Spine J, 2011, 20(9): 1496-1502.
6.	Faraj AA. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am), 2001, 83-A(3): 463-464.
7.	Moon M, Moon J, Moon Y, et al. Pott's paraplegia in patient with severely deformed dorsal or dorsolumbar spines: teatement and prognosis. Spinal Cord, 2003, 41(3): 164-171.
8.	Jin D, Qu D, Chen J, et al. One-stage anterior interbody autografting and instrumention in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J, 2004, 13(2): 114-121.
9.	Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop, 2012, 36(2): 353-357.
10.	Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine, 2007, 6(4): 320-326.
11.	贺茂林, 肖增明, 李世德, 等.侧前方入路一期病灶清除植骨内固定治疗腰骶段结核.中国脊柱脊髓杂志, 2009, 19(11): 818-822.
12.	Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12): 1677-1683.
13.	王锡阳, 庞晓阳, 李伟伟, 等.一期后路病灶清除植骨融合内固定治疗腰骶段脊柱结核.中国现代医学杂志, 2011, 21(28): 3527-3531.
14.	阿不都乃比·艾力, 张宏其, 唐明星, 等.单纯一期后路手术联合多枚分网异形钛网技术治疗腰骶段脊柱结核.中南大学学报(医学版), 2014, 39(12): 1313-1319.
15.	Degreif J, Wenda K, Runkel M, et al. Rotational stability of the tho-racolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5): 250-255.
16.	阮狄克, 吕维加, 费正奇, 等.节段开窗髓核摘除对腰椎稳定性的影响.中华骨科杂志, 1999, 19(5): 269-271.
17.	He D, Wu L, Chi Y, et al. Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage: finite element analysis and small clinical trials. Clin Biomech (Bristol, Avon), 2011, 26(3): 229-237.
18.	Adams MA, Hutton WC. The mechanical function of the lumbar apophysea joints. Spine (Phila Pa 1976), 1983, 8(3): 327-300.
19.	Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: The importance complex, and neurologic of injury morphology, the integrity of the posterior ligmentous status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
20.	瞿东滨, 金大地.正确认识脊柱结核病灶清除术.中国脊柱脊髓杂志, 2006, 18(8): 565-567.
21.	宋跃明.如何理解脊柱结核病灶彻底清除?中国脊柱脊髓杂志, 2010, 20(10): 798.
22.	王自立.进一步规范脊柱结核的治疗.中国脊柱脊髓杂志, 2010, 20(10): 793-794.
23.	罗卓荆.脊柱结核为什么要彻底清除病灶?中国脊柱脊髓杂志, 2010, 20(10): 797-798.
24.	戈朝晖, 王自立, 魏敏吉.脊柱结核病灶中抗痨药物浓度的测定.中华骨科杂志, 2005, 25(2): 97-101.
25.	张宏其, 陈筱, 郭虎兵, 等.单纯后路病灶清除椎体间植骨融合内固定治疗脊柱结核的适应证及疗效评价.中国矫形外科杂志, 2012, 20(3): 196-199.
26.	No authors listed. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1978, 60-B(2): 163-177.
27.	No authors listed. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Mason and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1985, 67(1): 103-110.
28.	张西峰, 夏志敏, 王岩, 等.微创方法提高病灶内药物浓度治疗脊柱结核的临床分析.第三军医大学学报, 2009, 31(20): 1936-1939.
29.	张西峰.用微创的视角解读《脊柱结核的手术策略》.中华骨科杂志, 2011, 31(4): 391-393.

1. 吴在德, 吴肇汉.外科学. 6版.北京:人民卫生出版社, 2005: 898.
2. 赵玉沛, 陈孝平.外科学. 3版.北京:人民卫生出版社, 2015: 991.
3. 蔡和, 汤泳强.脊柱不稳固X线表现及测量方法研究(附73例分析).放射学实践, 2000, 15(5): 362-364.
4. Bridwell KH, Lenke LG, McEnery KW, et al. Anterior fresh frozen structural allografts in the thoracic and lumbar spine. Do they work if combined with posterior fusion and instrumentation in adult patients with kyphosis or anterior column defects? Spine (Phila Pa 1976), 1995, 20(12): 1410-1418.
5. Nakshima H, Yukawa Y, Ito K, et al. Extension CT scan: its suitability for fusion after posterior lumbar interbody fusion. Eur Spine J, 2011, 20(9): 1496-1502.
6. Faraj AA. Anterior instrumentation for the treatment of spinal tuberculosis. J Bone Joint Surg (Am), 2001, 83-A(3): 463-464.
7. Moon M, Moon J, Moon Y, et al. Pott's paraplegia in patient with severely deformed dorsal or dorsolumbar spines: teatement and prognosis. Spinal Cord, 2003, 41(3): 164-171.
8. Jin D, Qu D, Chen J, et al. One-stage anterior interbody autografting and instrumention in primary surgical management of thoracolumbar spinal tuberculosis. Eur Spine J, 2004, 13(2): 114-121.
9. Issack PS, Boachie-Adjei O. Surgical correction of kyphotic deformity in spinal tuberculosis. Int Orthop, 2012, 36(2): 353-357.
10. Sai Kiran NA, Vaishya S, Kale SS, et al. Surgical results in patients with tuberculosis of the spine and severe lower-extremity motor deficits: a retrospective study of 48 patients. J Neurosurg Spine, 2007, 6(4): 320-326.
11. 贺茂林, 肖增明, 李世德, 等.侧前方入路一期病灶清除植骨内固定治疗腰骶段结核.中国脊柱脊髓杂志, 2009, 19(11): 818-822.
12. Zhang HQ, Lin MZ, Ge L, et al. Surgical management by one-stage posterior transforaminal lumbar debridement, interbody fusion, and posterior instrumentation for lumbo-sacral tuberculosis in the aged. Arch Orthop Trauma Surg, 2012, 132(12): 1677-1683.
13. 王锡阳, 庞晓阳, 李伟伟, 等.一期后路病灶清除植骨融合内固定治疗腰骶段脊柱结核.中国现代医学杂志, 2011, 21(28): 3527-3531.
14. 阿不都乃比·艾力, 张宏其, 唐明星, 等.单纯一期后路手术联合多枚分网异形钛网技术治疗腰骶段脊柱结核.中南大学学报(医学版), 2014, 39(12): 1313-1319.
15. Degreif J, Wenda K, Runkel M, et al. Rotational stability of the tho-racolumbar spine after interlaminar ultrasound window, hemilaminectomy and laminectomy. A comparative experimental study. Unfallchirurg, 1994, 97(5): 250-255.
16. 阮狄克, 吕维加, 费正奇, 等.节段开窗髓核摘除对腰椎稳定性的影响.中华骨科杂志, 1999, 19(5): 269-271.
17. He D, Wu L, Chi Y, et al. Facet joint plus interspinous process graft fusion to prevent postoperative late correction loss in thoracolumbar fractures with disc damage: finite element analysis and small clinical trials. Clin Biomech (Bristol, Avon), 2011, 26(3): 229-237.
18. Adams MA, Hutton WC. The mechanical function of the lumbar apophysea joints. Spine (Phila Pa 1976), 1983, 8(3): 327-300.
19. Vaccaro AR, Lehman RA, Hurlbert RJ, et al. A new classification of thoracolumbar injuries: The importance complex, and neurologic of injury morphology, the integrity of the posterior ligmentous status. Spine (Phila Pa 1976), 2005, 30(20): 2325-2333.
20. 瞿东滨, 金大地.正确认识脊柱结核病灶清除术.中国脊柱脊髓杂志, 2006, 18(8): 565-567.
21. 宋跃明.如何理解脊柱结核病灶彻底清除?中国脊柱脊髓杂志, 2010, 20(10): 798.
22. 王自立.进一步规范脊柱结核的治疗.中国脊柱脊髓杂志, 2010, 20(10): 793-794.
23. 罗卓荆.脊柱结核为什么要彻底清除病灶?中国脊柱脊髓杂志, 2010, 20(10): 797-798.
24. 戈朝晖, 王自立, 魏敏吉.脊柱结核病灶中抗痨药物浓度的测定.中华骨科杂志, 2005, 25(2): 97-101.
25. 张宏其, 陈筱, 郭虎兵, 等.单纯后路病灶清除椎体间植骨融合内固定治疗脊柱结核的适应证及疗效评价.中国矫形外科杂志, 2012, 20(3): 196-199.
26. No authors listed. Five-year assessments of controlled trials of ambulatory treatment, debridement and anterior spinal fusion in the management of tuberculosis of the spine. Studies in Bulawayo (Rhodesia) and in Hong Kong. Sixth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1978, 60-B(2): 163-177.
27. No authors listed. A 10-year assessment of controlled trials of inpatient and outpatient treatment and of plaster-of-Paris jackets for tuberculosis of the spine in children on standard chemotherapy. Studies in Mason and Pusan, Korea. Ninth report of the Medical Research Council Working Party on Tuberculosis of the Spine. J Bone Joint Surg (Br), 1985, 67(1): 103-110.
28. 张西峰, 夏志敏, 王岩, 等.微创方法提高病灶内药物浓度治疗脊柱结核的临床分析.第三军医大学学报, 2009, 31(20): 1936-1939.
29. 张西峰.用微创的视角解读《脊柱结核的手术策略》.中华骨科杂志, 2011, 31(4): 391-393.

Chinese Journal of Reparative and Reconstructive Surgery

One-stage posterior retaining part facet joint in laminectomy and debridement combined with short segmental pedicle screw fixation for lumbosacral spinal tuberculosis

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