APPLICATION OF LIMITED DECOMPRESSION COMBINED WITH VERTEBRAL PLATE RECONSTRUCTION ON TREATMENT OF SINGLE SEGMENT THORACIC VERTEBRA TUBERCULOSIS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LUO Yi , DENG Zhansheng , CHEN Jing , GUO Chaofeng.

Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha Hunan, 410008, P.R.China. Corresponding author: DENG Zhansheng, E-mail: dzsspine@163.com;

Corresponding author：

Keywords：

Single segment thoracic vertebra tuberculosis; Limited decompression; Absorbable haemostat; Vertebral plate reconstruction

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Objective To investigate the effectiveness in the treatment of single segment thoracic vertebra tuberculosis by limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation. Methods Between September 2005 and March 2010, 90 cases of single segment thoracic vertebra tuberculosis were treated by using limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation in 44 patients (treatment group) and by one-stage posterior approach, bone fusion, and internal fixation in 46 patients (control group). There was no significant difference in gender, age, disease duration, affected segment, Cobb angle, Frankle grade, erythrocyte sedimentation rate (ESR), and Oswestry disability index (ODI) between 2 groups (P gt; 0.05). Results All incisions healed by first intension. All 90 cases were followed up 24-44 months (mean, 38 months). There was no significant difference in ESR between 2 groups at 1 week and 3 months after operation (P gt; 0.05). Postoperative iconography indicated that the bone fusion rate of the treatment group was 100% and no epidural cicatricial tissue or failure of internal fixation was observed, showing significant difference when compared with control group (3 cases having failure of internal fixation) (P=0.032). The Cobb angles were significantly corrected after operation when compared with preoperative angles in 2 groups (P lt; 0.05). At 2 years after operation and at last follow-up, the Cobb angle and correction loss in treatment group were significantly better than those in control group (P lt; 0.05). The ODI and Frankel grade were significantly improved at last follow-up when compared with preoperative ones in 2 groups (P lt; 0.05); the treatment group was significantly better than the control group in the ODI, improvement rate of ODI (P lt; 0.05), and in Frankel grade (Uc=4.368, P=0.000). Conclusion Compared with conventional operation method, it is an ideal operation method to use limited decompression combined with epidural absorbable haemostat covering and vertebral plate reconstruction based on one-stage posterior approach, debridement, bone fusion, and internal fixation for treatment of single segment thoracic vertebra tuberculosis, with minimal wound, less complications, and good function recovery.

Citation： LUO Yi,DENG Zhansheng,CHEN Jing,GUO Chaofeng.. APPLICATION OF LIMITED DECOMPRESSION COMBINED WITH VERTEBRAL PLATE RECONSTRUCTION ON TREATMENT OF SINGLE SEGMENT THORACIC VERTEBRA TUBERCULOSIS. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(12): 1409-1414. doi: Copy

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2.	Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
3.	王自立. 对彻底治愈脊柱结核病灶及其相关问题的管见. 中国脊柱脊髓杂志, 2008, 18(8): 568-570.
4.	Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
5.	刘进, 刘浩, 李涛, 等. 单节段Coflex棘突间动力重建与后路360°植骨融合治疗腰椎退变性疾病的对比研究. 中国修复重建外科杂志, 2011, 25(6): 693-698.
6.	Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
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10.	Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
11.	Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
12.	Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
13.	Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
14.	Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
15.	Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
16.	张宇, 周初松, 蒋刚彪, 等. 壳聚糖/聚乙二醇琥珀酸酯/丝裂霉素C释药系统预防椎板切除术后硬脊膜外瘢痕粘连的实验研究. 中国修复重建外科杂志, 2008, 22(10): 1222-1226.
17.	庞祖才, 许汉权, 谢伟坚, 等. 预防椎板切除术后硬膜外粘连的实验研究. 中国修复重建外科杂志, 2006, 20 (12): 1176-1179.
18.	黄俊俊, 宋跃明, 刘立岷, 等. 聚乳酸薄膜预防腰椎间盘突出症术后硬膜外粘连的临床研究. 中国修复重建外科杂志, 2004, 18(1): 21-24.
19.	Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
20.	刘华春. 椎板切除术应用泰绫预防硬膜外瘢痕粘连. 中国当代医药, 2011, 18(21): 187, 190.
21.	唐欣, 杨述华, 李宝兴, 等. 同种异体骨板覆盖预防硬膜外瘢痕粘连的实验研究. 中国修复重建外科杂志, 2006, 20(8): 816-819.
22.	Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
23.	Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

1. Mehta JS, Bhojraj SY. Tuberculosis of the thoracic spine—A classification based on the selection of surgical strategies. J Bone Joint Surg (Br), 2001, 83(6): 859-863.
2. Garg B, Kandwal P, Nagaraja UB, et al. Anterior versus posterior procedure for surgical treatment of thoracolumbar tuberculosis: A retrospective analysis. Indian J Orthop, 2012, 46(2): 165-170.
3. 王自立. 对彻底治愈脊柱结核病灶及其相关问题的管见. 中国脊柱脊髓杂志, 2008, 18(8): 568-570.
4. Ma C, Wu S, Xiao L, et al. Responsiveness of the Chinese version of the Oswestry disability index in patients with chronic low back pain. Eur Spine J, 2011, 20(3): 475-481.
5. 刘进, 刘浩, 李涛, 等. 单节段Coflex棘突间动力重建与后路360°植骨融合治疗腰椎退变性疾病的对比研究. 中国修复重建外科杂志, 2011, 25(6): 693-698.
6. Reinhold M, Knop C, Beisse R, et al. Operative treatment of traumatic fractures of the thoracic and lumbar spinal column. Unfallchirurg, 2009, 112(1): 294-316.
7. 文永强, 詹伟彦, 何开正, 等. 有限潜行减压术治疗多节段腰椎间盘突出症疗效分析. 中国修复重建外科杂志, 2006, 20(4): 407-409.
8. Kim CW. Scientific basis of minimally invasive spine surgery: prevention of multifidus muscle injury during posterior lumbar surgery. Spine (Phila Pa 1976), 2010, 35(26 Suppl): S281-286.
9. Wurgler-Hauri CC, Kalbarczyk A, Wiesli M, et al. Dynamic neutralization of the lumbar spine after microsurgical decompression in acquired lumbar spinal stenosis and segmental instability. Spine (Phila Pa 1976), 2008, 33(3): E66-72.
10. Ma YZ, Cui X, Li HW, et al. Outcomes of anterior and posterior instrumentation under different surgical procedures for treating thoracic and lumbar spinal tuberculosis in adults. Int Orthop, 2012, 36(2): 299-305.
11. Xie JM, Li T, Wang YS, et al. Change in Cobb angle of each segment of the major curve after posterior vertebral column resection (PVCR): a preliminary discussion of correction mechanisms of PVCR. Eur Spine J, 2012, 21(4): 705-710.
12. Hsu WH, Lui TN, Chang CN, et al. Minimally invasive decompression with posterior column reinforcement for the treatment of symptomatic osteoporotic fracture with spinal stenosis in lumbar vertebrae. J Clin Neurosci, 2011, 18(12): 1645-1650.
13. Bokov A, Istrelov A, Skorodumov A, et al. An analysis of reasons for failed back surgery syndrome and partial results after different types of surgical lumbar nerve root decompression. Pain Physician, 2011, 14(6): 545-557.
14. Chandler K, Cappello R. Laminectomy membrane formation in dogs: Is the answer still elusive? Vet J, 2006, 172(1): 1-2.
15. Hollingworth W, Turner JA, Welton NJ, et al. Costs and cost-effectiveness of spinal cord stimulation (SCS) for failed back surgery syndrome: an observational study in a workers’ compensation population. Spine (Phila Pa 1976), 2011, 36(24): 2076-2083.
16. 张宇, 周初松, 蒋刚彪, 等. 壳聚糖/聚乙二醇琥珀酸酯/丝裂霉素C释药系统预防椎板切除术后硬脊膜外瘢痕粘连的实验研究. 中国修复重建外科杂志, 2008, 22(10): 1222-1226.
17. 庞祖才, 许汉权, 谢伟坚, 等. 预防椎板切除术后硬膜外粘连的实验研究. 中国修复重建外科杂志, 2006, 20 (12): 1176-1179.
18. 黄俊俊, 宋跃明, 刘立岷, 等. 聚乳酸薄膜预防腰椎间盘突出症术后硬膜外粘连的临床研究. 中国修复重建外科杂志, 2004, 18(1): 21-24.
19. Tao H, Fan H. Implantation of amniotic membrane to reduce postlaminectomy epidural adhesions. Eur Spine J, 2009, 18(8): 1202-1212.
20. 刘华春. 椎板切除术应用泰绫预防硬膜外瘢痕粘连. 中国当代医药, 2011, 18(21): 187, 190.
21. 唐欣, 杨述华, 李宝兴, 等. 同种异体骨板覆盖预防硬膜外瘢痕粘连的实验研究. 中国修复重建外科杂志, 2006, 20(8): 816-819.
22. Wee JH, Lee CH, Rhee CS, et al. Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients. Eur Arch Otorhinolaryngol, 2012, 269(3): 897-903.
23. Zhang H, Huang S, Guo H, et al. A clinical study of internal fixation, debridement and interbody thoracic fusion to treat thoracic tuberculosis via posterior approach only. Int Orthop, 2012, 36(2): 293-298.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF LIMITED DECOMPRESSION COMBINED WITH VERTEBRAL PLATE RECONSTRUCTION ON TREATMENT OF SINGLE SEGMENT THORACIC VERTEBRA TUBERCULOSIS

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