ObjectiveTo 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. MethodsBetween 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 L4, 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. ResultsThe 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. ConclusionOne-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.
ObjectiveTo evaluate the feasibility and the effectiveness of minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation for the treatment of Denis type B thoracolumbar burst fractures. MethodsBetween January 2013 and March 2015, 53 patients with Denis type B thoracolumbar burst fractures were treated by minimally invasive passage in posterior laminotomy decompression and intervertebral bone grafting combined with percutaneous pedicle screw fixation. There were 37 males and 16 females with a mean age of 43 years (range, 16-57 years). The causes included falling injury from height in 23 cases, traffic accident injury in 15 cases, heavy pound injury in 7 cases, and falling injury in 8 cases. The time between injury and operation was 7 hours to 12 days (mean, 6.7 days). The involved segments included T11 in 2 cases, T12 in 7 cases, L1 in 20 cases, L2 in 18 cases, and L3 in 6 cases; based on the neurological classification of spinal cord injury by American Spinal Injury Association (ASIA), 3 cases were rated as grade A, 5 cases as grade B, 12 cases as grade C, 24 cases as grade D, and 9 cases as grade E. The operation time, bleeding volume, and postoperative drainage were recorded; postoperative visual analogue scale (VAS) was used for pain evaluation, and ASIA for neurological function assessment; CT and X-ray films were taken to observe fracture healing, bone fusion, and grafted bone absorption; The vertebral canal patency rate was calculated; the relative height of fractured vertebrae and Cobb angle were measured. ResultsThe operation was successfully completed in all patients; the average operation time was 150 minutes (range, 90-240 minutes); the average bleeding volume was 350 mL (range, 50-500 mL); the average postoperative drainage was 80 mL (range, 20-150 mL); and the average VAS score was 2.3 (range, 1.5-4.7) at 3 days after operation. The incisions healed primarily. All the patients were followed up 12-19 months (mean, 15 months). All fractures healed at 3-9 months (mean, 6 months). No complications of broken nails, broken rod, and screw loosening occurred. At last follow-up, the vertebral canal patency rate was significantly improved when compared with preoperative value (t=27.395, P=0.000). The Cobb angle, and the anterior and posterior heights of of traumatic vertebra were significantly improved at 1 week, 1 year, and last follow-up when compared with preoperative ones (P < 0.05), but there was no significant difference between different time points after operation (P > 0.05). The neurological function was improved in different degrees; 1 case was rated as grade A, 4 cases as grade B, 7 cases as grade C, 15 cases as grade D, and 26 cases as grade E, showing significant difference when compared with preoperative one (Z=-5.477, P=0.000). ConclusionMinimally invasive passage in posterior laminotomy decompression, bone graft in the injured vertebrae combined with percutaneous pedicle screw fixation is an effective method to treat Denis type B thoracolumbar burst fractures, which not only can fully decompression, but also can effectively maintain the postoperative injured vertebral height, reduce the postoperative failure risk of internal fixation and decrease operation trauma.