scholarly journals Surgery for thoracolumbar junction (T12-L1) tuberculosis a multicentre, retrospective study

2019 ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  

Abstract Purpose A multicentre, retrospective study was conducted to evaluate the safety and efficacy of different surgical techniques for thoracolumbar junction (T12-L1) tuberculosis. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 257) from January 2005 to January 2015 were collected and reviewed. A total of 45 patients were operated on by an anterior approach (Group A), 52 by a combined anterior and posterior approach (Group B) and 160 by a posterior approach (Group C). Anti-tuberculosis therapy was performed both before and after surgery. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Results All three surgical approaches achieved bone fusion, pain relief and neurological recovery. The mean loss of correction in group A at last follow-up was higher than in groups B and C (P < 0.05), and the difference between groups B and C was not significant (P > 0.05). The mean operation time and blood loss in group B were greater than in groups A and C. Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only approach is superior to the anterior-only approach in the correction of kyphosis and maintenance of spinal stability. The posterior-only approach is recommended because it achieves the same efficacy as the anterior-only or combined approach but with shorter operation times, less trauma and less blood loss. Keywords Spinal tuberculosis; Thoracolumbar junction; Three approaches.

2020 ◽  
Vol 134 (9) ◽  
pp. 779-783
Author(s):  
D Wang ◽  
W Wang

AbstractObjectiveThe aim of this study was to compare the differences between the no tympanomeatal flap approach and the tympanomeatal flap approach in endoscopic myringoplasty.MethodA total of 132 patients with tympanic membrane perforation were randomly divided into two groups: the no tympanomeatal flap approach group (group A, 56 ears) and the tympanomeatal flap approach group (group B, 76 ears). A comparison between the two groups was made.ResultsThe average operation time of group A was 36.00 ± 5.24 minutes, which was significantly shorter than that of group B, which was 43.89 ± 4.57 minutes (p = 0.002). The blood loss of group A was 5.08 ± 1.83 ml, which was significantly less than that of group B (9.67 ± 2.29 ml; p < 0.001). There were no differences in the degree of hearing improvement, the rate of hearing improvement, the dry ear time (when the external auditory canal and the operating cavity were dry) after operation and the success rate of tympanic membrane repair when compared between the two groups.ConclusionCompared with group B, group A (no tympanomeatal flap approach) can achieve the same effect but has the advantages of a shorter operation time and less blood loss during the operation.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  

Abstract Background The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. Forty-five patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2 ± 45.4 min, 408.0 ± 54.3 min, 227.9 ± 58.5 min, and the blood loss was 744.0 ± 193.8 ml, 1134.6 ± 328.2 ml, 349.8 ± 289.4 ml in groups A, B and C respectively. The average loss of correction was 5.5 ± 3.7° in group A, 1.6 ± 1.9° in group B, 1.7 ± 2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.


2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Weiwei Li ◽  
Zheng Liu ◽  
Xiao Xiao ◽  
Zhen Zhang ◽  
Xiyang Wang

Abstract Background The surgical procedures for mid-thoracic spinal tuberculosis mainly include anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion. Until now, the surgical choice is still controversial. This study aims to compare the clinical efficacy of anterior transthoracic debridement and fusion with posterior transpedicular debridement and fusion in the treatment of mid-thoracic (T5–9) spinal tuberculosis in adult patients. Methods Eighty-seven cases with mid-thoracic spinal tuberculosis were treated with anterior transthoracic debridement and fusion (Group A, n = 39) and posterior transpedicular debridement and fusion (Group B, n = 48) from January 2007 to June 2014. Parameters including the operation time, blood loss, time of ESR and CRP decreasing to the normal level, time of abscess disappearance, time of bone graft fusion, rate of surgical complications, Visual Analog Scale (VAS) score, kyphosis angle and SF-36 scale were compared between two groups to evaluate their therapeutic effects. Results All patients were followed up for 5–10 years with the mean of 6.2 ± 1.1 years. No significant differences were observed regarding the gender composition ratio, age, course of disease, number of lesion segments, and preoperative indexes of ESR, CRP, VAS score, kyphosis angle and SF-36 scale between the two groups. Besides, no significant differences were observed regarding VAS score, kyphosis angle and SF-36 scale between the two groups in the 5th postoperative year (P > 0.05). However, the operation time (158.2 ± 10.7 min vs. 183.7 ± 14.1 min), blood loss (517.9 ± 76.5 ml vs.714.6 ± 57.4 ml), time of ESR (2.3 ± 1.1 months vs.3.1 ± 1.4 months) and CRP (1.1 ± 0.3 months vs.1.2 ± 0.6 months) decreasing to the normal level, time of abscess disappearance (2.7 ± 1.6 months vs.4.9 ± 1.9 months), and time of bone graft fusion (6.6 ± 0.8 months vs.8.0 ± 9.6 months) in Group A were less than those in Group B (P < 0.05). Conclusions Both anterior transthoracic debridement and fusion and posterior transpedicular debridement and fusion have a low risk of surgical complications and provide good quality of life for the patients with mid-thoracic (T5–9) spinal tuberculosis followed up in the mid-term. Moreover, the anterior procedure leads to early resolution of the disease and faster fusion.


2019 ◽  
Vol 26 (04) ◽  
Author(s):  
Fayyaz Ahmad Orfi ◽  
Asrar Ahmad ◽  
Irum Saleem ◽  
Maheen Orfi

Objectives: To compare lateral versus posterior approach in the management of supracondylar fractures of humerus in children in terms of functional outcome. Study Design: Retrospective Comparative study. Place and Duration of Study: This retrospective study was carried out over a period of seven years from Oct 2009 to Oct 2016, at Combined Military Hospitals Kharian, Malir and Nowshera. Patients and Methods: All the children having supracondylar fracture (Gartland Type-II and III) who underwent surgical intervention either by posterior or lateral approach were included in the study. In Group-A children operated by posterior approach were placed while in Group-B children were operated by posterior approach. They were followed up in OPD after 6 months. The final functional and cosmetic outcome was assessed by using Flynn’s criteria. Data was analysed by using SPSS version -20. A p-value of less than 0.05 was considered as statistically significant. Results: A total of 104 cases were operated during this study period. Fifty-four cases were done by posterior approach (Group-A), while 50 cases were operated by lateral approach (Group-B). In Group-A the mean age was 6.1 years while in Group-B, mean age was 6.6 years. In Group-A the male to female ratio was 72:28 while in Group-B it was 64:36. The mean weight in Group-A was 19.81Kgs (SD: ±4.53) while in Group-B it was 20.44 Kgs (SD:± 3.97). The mean operative time in Group-A was 36.30 minutes (SD: ±3.32) and in Group-B it was 23.58 minutes (SD: ±2.12). The functional outcome at six months follow-up was excellent in 35 (65%), good in 8 (15%), fair in 7 (13%) and poor in 4(7%) cases in Group-A while in Group-B it was excellent in 35 (70%), good in 10 (20%), fair in 4 (8%) and poor in only one case (2%). This difference was not significant at a p-value of 0.441. Conclusion: Though lateral approach required less operative time but there was no statistically significant difference from the posterior approach comparing the functional outcome in the management of paediatric supracondylar fractures of humerus.


2019 ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results: All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The average loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.


Author(s):  
Hangli Wu ◽  
Yaqing Cui ◽  
Liqun Gong ◽  
Jun Liu ◽  
Yayi Fan ◽  
...  

Abstract Purpose To compare the efficacy of single anterior and single posterior approach of debridement, interbody fusion, and fixation for the treatment of mono-segment lumbar spine tuberculosis (TB) patients. Methods Eighty-seven patients with mono-segment lumbar TB who underwent debridement, interbody fusion, and fixation through either single anterior (Group A) or single posterior approach (Group B) from January 2007 to January 2017 were enrolled in this study. The duration of the operation, blood loss, complication rate, visual analog scale (VAS), Oswestry disability index (ODI), Frankel scale, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), kyphosis angle, correction rate, correction loss, and time taken for bone graft fusion were compared between the groups. Results The average period of follow-up was 34.3 ± 9.5 months (24–56 months). No significant differences were observed between patients in Group A and patients in Group B in terms of gender, age, body mass index (BMI), duration of illness and preoperative evaluative indices (P > 0.05). The mean operation time and blood loss was significantly higher in Group A (P = 0.000), along with a slightly higher rate of complications compared with Group B (P = 0.848). The VAS, ODI and Frankel scale scores showed significant improvement in both groups (P = 0.000), along with the ESR, CRP and kyphosis indices (P = 0.000), which were similar in both groups at the final follow-up. Conclusion Both single anterior and single posterior approaches of debridement, interbody fusion and fixation are effective for mono-segment lumbar TB patients, although the single posterior approach is of a shorter duration and results in less blood loss.


2019 ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three surgical approaches through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion in a single- or two-stage procedure (Group B) and 80 underwent posterior debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological results of the three groups were compared. Operations at each centre were performed by the same senior medical team in each centre. Results: All three surgical approaches achieved bone fusion and pain relief. All patients with neurological deficits had different degrees of recovery after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The mean loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is superior to the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as the anterior-only or combined procedure but with shorter operation times, less trauma and less blood loss. Keywords: Spinal tuberculosis; Thoracolumbar junction lesion; Surgical treatment; Outcome.


2020 ◽  
Vol 1 (1) ◽  
pp. 5
Author(s):  
Muhammad Ahmed Khan ◽  
Attique Ahmed ◽  
Muhammad Khan

Objective: To compare early versus interval tonsillectomy in cases of peritonsillar abscess.Study Design: Comparative study.Place and Duration of Study: The study was carried out at ENT Department of Combined Military Hospital, Mardan from January 2017 to January 2018.Materials and Methods: A total 50 patients were selected from ENT outpatient department. All the cases were randomly divided into two groups of 25 each. Group A underwent early tonsillectomy after initial incision and drainage, Group B underwent interval tonsillectomy after 6 weeks. Both the groups were compared in terms of perioperative blood loss, operation time, ease of dissection and postoperative complications including pain and hemorrhage. Tonsillectomy was done with bipolar cautery in all the cases.Results: The mean age was 30.22 + 8.25. Out of 50 patients, 42 (84%) were males and 8 (16%) were females. The mean operative time of surgery in group A (early tonsillectomy) was 45.04+5.78 minutes compared to 32.72+4.37 minutes for group B (interval tonsillectomy (p=0.00). Mean post-operative pain in group A was 3.68+2.12 compared to group B where mean score was 3.36+1.93 (p=0.579). There were 3 cases of mild perioperative blood loss, 19 cases of moderate and 3 of severe perioperative blood loss in group A. There were 18 cases of mild perioperative blood loss, 7 cases of moderate and no case of severe perioperative blood loss in group B (p=0.00). Dissection was found to be significantly easier in group B (interval tonsillectomy). There were 7 cases of post-op secondary hemorrhage in group A compared to 3 in group B (p=0.289). All these cases of secondary hemorrhage were managed conservatively.Conclusion: Interval tonsillectomy is a safer procedure as compared to early tonsillectomy in terms of perioperative blood loss, operative time, dissection with almost similar post-op pain and similar risk of post tonsillectomy hemorrhage. How to cite this: Khan MA, Ahmed A, Khan M.  Comparison of Early versus Interval Tonsillectomy in Cases of Peritonsillar Abscess. Life and Science. 2020; 1(1): 24-28.  doi: https://doi.org/10.37185/L&S.1.1.13


2019 ◽  
Author(s):  
Yanping Zeng ◽  
Peng Cheng ◽  
Jiulin Tan ◽  
Zhilin Li ◽  
Yuan Chen ◽  
...  

Abstract Background: The surgical approaches to thoracolumbar junction (T12-L1) tuberculosis were controversial. We aimed to compare the safety and efficacy of three different procedures through a multicentre retrospective study. Methods: The medical records of thoracolumbar junction tuberculosis patients (n = 177) from January 2005 to January 2015 were collected and reviewed. 45 patients underwent anterior debridement and instrumented fusion (Group A), 52 underwent anterior combined with posterior debridement and instrumented fusion (Group B) and 80 underwent posterior-only debridement and instrumented fusion (Group C). Patients with neurological deficit were 10 in Group A, 23 in Group B, 36 in Group C. All patients had a standard preoperative and postoperative anti - tuberculous therapy regimen. Clinical outcomes, laboratory indexes and radiological evaluation of the three groups were compared. Operations at each centre were performed by the respective senior medical teams of the six different hospitals. Results: All three surgical approaches achieved bone fusion and pain relief. Cases with neurological deficits had different degrees of improvement after surgery. The operative time was 330.2±45.4min, 408.0±54.3min, 227.9±58.5min, and the blood loss was 744.0±193.8ml, 1134.6±328.2ml, 349.8±289.4ml in groups A, B and C respectively. The average loss of correction was 5.5±3.7° in group A, 1.6±1.9° in group B, 1.7±2.2° in group C, and the difference between groups except B vs C were of statistically significant (P < 0.05). Conclusions: For patients with thoracolumbar junction (T12-L1) tuberculosis, the posterior-only procedure is the better than the anterior-only procedure in the correction of kyphosis and maintenance of spinal stability. The posterior-only procedure is recommended because it achieves the same efficacy as combined procedure with shorter operation time, less blood loss and trauma.


2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e16135-e16135
Author(s):  
Xijie Zhang ◽  
Junli Zhang ◽  
Yuzhou Zhao

e16135 Background: The medial to lateral approach Laparoscopic right hemicolectomy complies with the “no-touch” principle, but need a demanding procedure with a steep learning curve. This study was designed to assess the superiority of the tunnel approach compared to traditional medial-to-lateral approach in laparoscopic right hemicolectomy for patients with right-sided colon cancer. Methods: The new method was called Tunnel Approach: The tunnel was formed with Toldt's gap was dissociated upward from the attachment of ileocecal part and retroperitoneum, then the right mesocolon was lifted to expose and divide the superior mesenteric blood vessel. We analyzed retrospectively the patients with resectable right-sided colon cancer confirmed by colonoscope and imaging who received the laparoscopic radical right hemicolectomy. The patients were divided into the tunnel approach (group A) and the traditional medial-to-lateral approach (group B) according to the surgical maneuver performed. Results: A total of 84 patients who received laparoscopic radical right hemicolectomy were assigned to group A (n = 42) or group B (n = 42) between January 2016 to June 2017. There was no difference in baseline characteristics including demographics, body mass index (BMI), tumor stage, tumor location and differentiation. The operation time and intraoperative blood loss in group A were significantly better than group B (137.74±22.7 vs. 153.1±28.8min, p < 0.05; 49.0±40.7 vs. 142.9±87.4ml, p < 0.05, respectively).There was no difference in tumor size(5.7±2.1 vs. 5.7±2.1cm, p>0.05), conversion to laparotomy rate(0 vs. 3, p>0.05), lymph node yield(30.5±14.4 vs. 27.9±12.7, p>0.05), time to first flatus(3.4±1.3 vs. 4.0±1.3d, p>0.05), postoperative hospital stays(10.0±2.2 vs. 12.3±3.0d, p>0.05) and complications(2 vs. 3, p>0.05) between two groups. There was no treatment-related death in both groups. Conclusions: The characteristic of “tunnel” approach is to convert the anatomy from a two-dimensional to a three-dimensional view, it showed the benefits of both speed and safety with low intraoperative conversion to laparotomy rate and mortality. This new tunnel approach right hemicolectomy is worth recommended.


Sign in / Sign up

Export Citation Format

Share Document