scholarly journals Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

2020 ◽  
Author(s):  
Zenghui Zhao ◽  
Jianxiao Li ◽  
Qiqi Peng ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Grafting ◽  
Single Stage ◽  
Anterior Column ◽  
Surgical Trauma ◽  
Bone Fusion ◽  
Significant Difference ◽  
Anterior Column Support ◽  
Posterior Debridement

Abstract Background Various bone grafting have been reported to achieve anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar tuberculosis. However, nonstructural bone grafting has been rarely studied. This study aimed to compare the efficacy of nonstructural bone grafting versus structural bone grafting in the treatment of lumbar tuberculosis.Patients and methods We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g. Visual Analog Scale for back pain, the Oswestry Disability Index) were collected before surgery and at follow-up.Results Both nonstructural and structural bone grafting were associated with significant improvements in the quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting resulted in the significantly less operation duration, blood loss and lower bone fusion rate than structural bone grafting group. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups. Conclusions Nonstructural bone grafting can achieve anterior column support with less surgical trauma and simpler surgical procedure than structural bone grafting, but the lower rate of grafted bone fusion should be taken into consideration when choosing nonstructural bone grafting. Key words Lumbar tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; Nonstructural bone grafting; Structural bone grafting

scholarly journals Nonstructural versus structural bone grafting in the treatment of lumbar tuberculosis: a retrospective cohort study

2020 ◽  
Author(s):  
Zenghui Zhao ◽  
Jianxiao Li ◽  
Qiqi Peng ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Grafting ◽  
Fusion Rate ◽  
Anterior Column ◽  
Surgical Trauma ◽  
Bone Fusion ◽  
Significant Difference ◽  
Anterior Column Support ◽  
Posterior Debridement

Abstract [Background] Various bone grafting have been reported to achieve anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar tuberculosis. However, nonstructural bone grafting has been rarely studied. This study aimed to compare the efficacy of nonstructural bone grafting versus structural bone grafting in the treatment of lumbar tuberculosis.[Patients and methods] We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g. Visual Analog Scale for back pain, the Oswestry Disability Index) were collected before surgery and at follow-up. [Results] Both nonstructural and structural bone grafting were associated with significant improvements in the quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting resulted in the significantly less operation duration, blood loss and lower bone fusion rate than structural bone grafting group. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups.[Conclusions] Nonstructural bone grafting can achieve anterior column support with less surgical trauma and simpler surgical procedure than structural bone grafting, but the lower rate of grafted bone fusion should be taken into consideration when choosing nonstructural bone grafting.

Nonstructural versus structural bone grafting in the treatment of lumbar spinal tuberculosis combined with single-stage posterior debridement and instrumentation: a retrospective cohort study

2020 ◽  
Author(s):  
Zenghui Zhao ◽  
Jianxiao Li ◽  
Qiqi Peng ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Single Stage ◽  
Anterior Column ◽  
Bone Fusion ◽  
Anterior Column Support ◽  
Lumbar Spinal ◽  
Posterior Debridement

Abstract Background Many types of bone grafting have been reported for successful use in achieving anterior column support and bone fusion after one stage posterior debridement in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the feasibility of none-structural bone grafting from comparing the advantages and disadvantages with structural bone grafting in the treatment of lumbar spinal tuberculosis. Patients and methods We retrospectively reviewed patients with lumbar spinal tuberculosis who had undergone none-structural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, and computed tomography scans, as well as health-related outcomes, including Visual Analog Scale for back pain, the Oswestry Disability Index were collated before surgery and at follow-up. Results Both none-structural and structural bone grafting were associated with significant improvements in quality of life parameters, the laboratory tests and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was in both two groups, without any associated complications. The operation duration and blood loss in none-structural bone grafting group was significantly less. The bone fusion rate was higher in structural bone grafting group. There were three complications in the none-structural bone grafting and four complications in the structural bone grafting group; the incidence of complications between the two groups was not significantly different. Conclusions Based on single-stage posterior debridement and pedicle screws fixation, none-structural bone grafting can achieve anterior column support with reducing surgical trauma, simplifying surgical procedure and decreasing intraoperative hemorrhage, but the lower rate of grafted bone fusion should be taken into consideration when choosing the aforementioned method. Key words Lumbar spinal tuberculous; Single-stage posterior debridement; Anterior column support; Bone fusion; None-structural bone grafting; Structural bone grafting

scholarly journals Nonstructural Versus Structural Bone Grafting for Interbody Fusion in the Treatment of Lumbar Tuberculosis by a Single Posterior Approach

2021 ◽  
Author(s):  
Zenghui Zhao ◽  
Jianxiao Li ◽  
Wei Luo ◽  
Yong Zhu ◽  
Xing Du ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Bone Grafting ◽  
Interbody Fusion ◽  
Spinal Tuberculosis ◽  
Pedicle Screws ◽  
Surgical Trauma ◽  
Single Segment ◽  
One Stage ◽  
Significant Difference ◽  
Posterior Debridement

Abstract Background Many types of bone grafting have been reported for successful use in the treatment of lumbar spinal tuberculosis. However, none-structural bone grafting has rarely been studied. This study was aimed to identify the clinical efficacy of nonstructural with structural bone graft for interbody fusion in the surgical treatment of single segment lumbar tuberculosis after one stage posterior debridement.Methods We retrospectively reviewed patients with nonstructural (n=27) and structural (n=22) bone grafting after single-stage posterior debridement and instrumentation for lumbar tuberculosis with at least 24 months of follow-up. Plain radiographs, magnetic resonance imaging, computed tomography scans, and health-related outcomes (e.g., Visual Analog Scale for back pain, the Oswestry Disability Index) were collected and analyzed before and after surgery. Results Both nonstructural and structural bone grafting were associated with significant improvements in the life quality parameters, the laboratory tests, and the Cobb angle of local kyphosis. A slight loss of Cobb angle correction was observed in two groups. Nonstructural bone grafting exhibited the advantages of less operation duration, blood loss and lower bone fusion rate compared with structural bone grafting. There were three complications in the nonstructural bone grafting and four complications in the structural bone grafting group, with no significant difference between two groups.Conclusions In conclusion, nonstructural bone grafting can achieve comparable interbody fusion to structural bone grafting but has less surgical trauma and simpler surgical procedure than structural bone grafting in the treatment of single segment lumbar tuberculosis after one stage posterior debridement and pedicle screws fixation.

scholarly journals Long-term outcome of polymethylmethacrylate-augmented screw fixation in the treatment of thoracolumbar spinal tuberculosis in elderly patients with severe osteoporosis

2020 ◽  
Author(s):  
Jun-Song Yang ◽  
Bao-Rong He ◽  
Jian-Min Wei ◽  
Xiang-Fu Wang ◽  
Dongmei Wei ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cobb Angle ◽  
Bone Grafting ◽  
Screw Fixation ◽  
Spinal Tuberculosis ◽  
Implant Failure ◽  
Severe Osteoporosis ◽  
Posterior Debridement ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background: to evaluate the safety and efficacy of Polymethylmethacrylate-augmented screw fixation (PASF) in the treatment of elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis.Methods: 34 elderly patients with thoracolumbar spinal tuberculosis accompanied with severe osteoporosis underwent PASF after anterior or posterior debridement and bone grafting in our hospital from January 2010 to January 2012. The follow-ups were performed at 1, 3, 6, and 12 months postoperatively and then annually thereafter. The segmental cobb angle was measured to evaluate kyphosis improvement. The laboratory examination including ESR and CRP was also monitored. The pre- and postoperative VAS score, ODI score, and neurological function of ASIA scale were also recorded.Results: The included 21 patients completed the operation successfully. In all patients with neurological dysfunction, the ASIA grade improved by at least 1 grade. One month postoperatively, the VAS score, ODI, segmental Cobb angle, ESR, and CRP were significantly improved compared with those preoperatively (P<0.05); there was no significant difference in the values at 1 month postoperatively and last follow-up (P＞0.05). There were no complications such as implant failure, proximal junctional kyphosis, or recurrence of tuberculosis at the minimum 5-year follow-up. Conclusion: For elderly patients with thoracolumbar spinal tuberculosis complicated with severe osteoporosis, after anterior or posterior debridement and bone grafting, together with postoperative systematic anti-tuberculosis and anti-osteoporosis treatments, PASF is safe and effective without catastrophic complications such as intraspinal cement leakage. During the 5-year follow-up, there was no tuberculosis recurrence or implant failure.

scholarly journals Treatment of thoracolumbar trauma by short-segment percutaneous transpedicular screw instrumentation: prospective comparative study with a minimum 2-year follow-up

2014 ◽  
Vol 20 (2) ◽  
pp. 150-156 ◽  
Author(s):  
Petr Vanek ◽  
Ondrej Bradac ◽  
Renata Konopkova ◽  
Patricia de Lacy ◽  
Jiri Lacman ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Cobb Angle ◽  
Control Group ◽  
Working Ability ◽  
Short Segment ◽  
Transpedicular Screw ◽  
Significant Difference ◽  
Screw Group

Object The main aim of this study was to compare clinical and radiological outcomes after stabilization by a percutaneous transpedicular system and stabilization from the standard open approach for thoracolumbar spine injury. Methods Thirty-seven consecutive patients were enrolled in the study over a period of 16 months. Patients were included in the study if they experienced 1 thoracolumbar fracture (A3.1–A3.3, according to the AO/Magerl classification), had an absence of neurological deficits, had no other significant injuries, and were willing to participate. Eighteen patients were treated by short-segment, minimally invasive, percutaneous pedicle screw instrumentation. The control group was composed of 19 patients who were stabilized using a short-segment transpedicular construct, which was performed through a standard midline incision. The pain profile was assessed by a visual analog scale (VAS), and overall satisfaction by a simple 4-stage scale relating to performance of daily activities. Working ability and return to original occupation were also monitored. Radiographic follow-up was defined by the vertebral body index (VBI), vertebral body angle (VBA), and bisegmental Cobb angle. The accuracy of screw placement was examined using CT. Results The mean surgical duration in the percutaneous screw group was 53 ± 10 minutes, compared with 60 ± 9 minutes in the control group (p = 0.032). The percutaneous screw group had a significantly lower perioperative blood loss of 56 ± 17 ml, compared with 331 ± 149 ml in the control group (p < 0.001). Scores on the VAS in patients in the percutaneous screw group during the first 7 postoperative days were significantly lower than those in the control group (p < 0.001). There was no significant difference between groups in VBI, VBA, and Cobb angle values during follow-up. There was no significant difference in screw placement accuracy between the groups and no patients required surgical revision. There was no significant difference between groups in overall satisfaction at the 2-year follow-up (p = 0.402). Working ability was insignificantly better in the percutaneous screw group; previous working position was achieved in 17 patients in this group and in 12 cases in the control group (p = 0.088). Conclusions This study confirms that the percutaneous transpedicular screw technique represents a viable option in the treatment of preselected thoracolumbar fractures. A significant reduction in blood loss, postoperative pain, and surgical time were the main advantages associated with this minimally invasive technique. Clinical, functional, and radiological results were at least the same as those achieved using the open technique after a 2-year follow-up. The short-term benefits of the percutaneous transpedicular screw technique are apparent, and long-term results have to be studied in other well-designed studies evaluating the theoretical benefit of the percutaneous technique and assessing whether the results of the latter are as durable as the ones achieved by open surgery.

scholarly journals Efficacy Analysis of One-stage Posterior-only Surgical Treatment for Thoracic Spinal Tuberculosis in the T4-6 Segments with Minimum 5-year Follow-up

2021 ◽  
Author(s):  
Yi Zhan ◽  
Xin Kang ◽  
Wenjie Gao ◽  
Xinliang Zhang ◽  
Lingbo Kong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Cobb Angle ◽  
Clinical Efficacy ◽  
Spinal Tuberculosis ◽  
Surgical Trauma ◽  
Posterior Surgery ◽  
One Stage ◽  
Thoracic Spinal ◽  
Thoracic Spinal Tuberculosis

Abstract In recent years, with the in-depth research on spinal tuberculosis, posterior surgery alone has been praised highly by more and more surgeons due to the better correction of kyphosis, better maintenance of spinal physiological curvature, smaller surgical trauma and fewer surgical complications. However, there is currently lack of relevant reports about the efficacy of posterior surgery alone in the treatment of tuberculosis in the T4-6 segments. This study aimed to evaluate the clinical study efficacy and feasibility of one-stage posterior-only surgical treatment for thoracic spinal tuberculosis in the T4-6 segments. 67 patients with tuberculosis in T4-6 segments who underwent one-stage posterior-only surgery were included in this study. The clinical efficacy was evaluated using statistical analysis based on the data about erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Oswestry Dability Index (ODI) score, Visual Analogue Scale (VAS) score and Cobb angle before surgery, after surgery and at the last follow-up. All patients completed fusion during the follow-up period of 6–9 months. ESR and CRP were returned to normal for all patients at 6 months follow-up. In the meanwhile, among the 27 patients combined with neurological impairment, neurological functions of 22 cases (81.48%) recovered completely at the last follow-up (P < 0.05). Cobb angle of the kyphosis was improved from preoperative 34.8 ± 10.9° to postoperative 9.6 ± 2.8°, maintaining at 11.3 ± 3.2° at the last follow-up, The ODI and VAS scores were improved by 77.10% and 81.70%, respectively. This 5-year follow-up study shows that better clinical efficacy can be achieved for tuberculosis in T4-6 segments using one-stage posterior-only approach by costotransverse debridement in combination with bone graft and internal fixation. The posterior surgical method cannot only effectively accomplish debridement, obtain satisfactory clinical results, but also well correct kyphotic deformity and maintain it.

scholarly journals Single-Stage Posterior Vertebral Column Resection With Circumferential Reconstruction for Thoracic/Thoracolumbar Burst Fractures With or Without Neurological Deficit: Clinical Neurological and Radiological Outcomes

2020 ◽  
pp. 219256822096445
Author(s):  
Azmi Hamzaoglu ◽  
Mustafa Elsadig ◽  
Selhan Karadereler ◽  
Ayhan Mutlu ◽  
Yunus Emre Akman ◽  
...  
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Single Stage ◽  
Anterior Column ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Thoracolumbar Burst Fractures ◽  
Burst Fractures ◽  
The Mean

Study Design: Retrospective study. Objective: The aim of this study is to evaluate the clinical, neurological, and radiological outcomes of posterior vertebral column resection (PVCR) technique for treatment of thoracic and thoracolumbar burst fractures. Methods: Fifty-one patients (18 male, 33 female) with thoracic/thoracolumbar burst fractures who had been treated with PVCR technique were retrospectively reviewed. Preoperative and most recent radiographs were evaluated and local kyphosis angle (LKA), sagittal and coronal spinal parameters were measured. Neurological and functional results were assessed by the American Spinal Injury Association (ASIA) Impairment Scale, visual analogue scale score, Oswestry Disability Index, and Short Form 36 version 2. Results: The mean age was 49 years (range 22-83 years). The mean follow-up period was 69 months (range 28-216 months). Fractures were thoracic in 16 and thoracolumbar in 35 of the patients. AO spine thoracolumbar injury morphological types were as follows: 1 type A3, 15 type A4, 4 type B1, 23 type B2, 8 type C injuries. PVCR was performed in a single level in 48 of the patients and in 2 levels in 3 patients. The mean operative time was 434 minutes (range 270-530 minutes) and mean intraoperative blood loss was 520 mL (range 360-1100 mL). The mean LKA improved from 34.7° to 4.9° (85.9%). For 27 patients, the initial neurological deficit (ASIA A in 8, ASIA B in 3, ASIA C in 5, and ASIA D in 11) improved at least 1 ASIA grade (1-3 grades) in 22 patients (81.5%). Solid fusion, assessed with computed tomography at the final follow-up, was achieved in all patients. Conclusion: Single-stage PVCR provides complete spinal canal decompression, ideal kyphosis correction with gradual lengthening of anterior column together with sequential posterior column compression. Anterior column support, avoidance of the morbidity of anterior approach and improvement of neurological deficit are the other advantages of the single stage PVCR technique in patients with thoracic/thoracolumbar burst fractures.

Efficacy of anterior cervical decompression and fusion procedures for monomelic amyotrophy treatment: a prospective randomized controlled trial

2013 ◽  
Vol 19 (4) ◽  
pp. 412-419 ◽  
Author(s):  
Feizhou Lu ◽  
Hongli Wang ◽  
Jianyuan Jiang ◽  
Wenjun Chen ◽  
Xin Ma ◽  
...  
Keyword(s):  
Bone Grafting ◽  
Iliac Crest ◽  
Plate Fixation ◽  
Cervical Collar ◽  
Therapeutic Effects ◽  
Iliac Crest Bone Grafting ◽  
Anterior Cervical Decompression ◽  
Significant Difference ◽  
Internal Plate Fixation

Object Monomelic amyotrophy (MMA) is a benign, self-limiting lower motor neuron disease. Optimal surgical strategies—discectomy decompression and fusion (DDF) or corpectomy decompression and fusion (CDF)—for patients with aggravated symptoms (within 6 months of presentation) are controversial, particularly in those who are ineligible for conventional treatment. These 2 methods of anterior cervical decompression and fusion for MMA in patients unwilling or unable to wear a conventional cervical collar long term were evaluated. Methods Anterior cervical decompression and fusion were performed in 48 male patients with MMA between September 2007 and September 2010. Patients were randomly treated with anterior cervical discectomy decompression with autologous iliac crest bone grafting and internal plate fixation (DDF group: 24 patients) or anterior cervical corpectomy, posterior longitudinal ligament resection, autologous iliac crest bone grafting, and internal plate fixation (CDF group: 24 patients). Subjective symptom assessments and electromyography (EMG) examinations were conducted both preoperatively and postoperatively. Results Subjective assessments and EMG studies (mean follow-up duration 25.9 months) indicated improvement in 64.6% and 60% of patients, respectively. No significant correlations between the effectiveness of surgery and age at symptom onset, preoperative symptom duration, or postoperative follow-up time were found. Conclusions The lack of a significant difference in effectiveness between DDF and CDF favors DDF as more clinically applicable because of its lower procedural risks. As a second-line alternative to cervical collar treatment, surgical anterior cervical decompression and fusion via DDF or CDF may prevent further deterioration and produce good short-term therapeutic effects in patients with MMA; however, cervical collar treatment is recommended for eligible patients because of its lower associated risks.

Unilateral transforaminal lumbar interbody fusion and bilateral anterior-column fixation with two Brantigan I/F cages per level: clinical outcomes during a minimum 2-year follow-up period

2006 ◽  
Vol 4 (3) ◽  
pp. 198-205 ◽  
Author(s):  
Hiroshi Taneichi ◽  
Kota Suda ◽  
Tomomichi Kajino ◽  
Akira Matsumura ◽  
Hiroshi Moridaira ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Interbody Fusion ◽  
Japanese Orthopaedic Association ◽  
Posterior Lumbar Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Anterior Column ◽  
Lumbar Interbody Fusion ◽  
Anterior Column Support ◽  
The Mean

Object There are no published reports of unilateral transforaminal lumbar interbody fusion (TLIF) in which two Brantigan I/F cages were placed per level through a single portal to achieve bilateral anterior-column support. The authors describe such a surgical technique and evaluate the clinical outcomes of this procedure. Methods Data obtained in 86 (93.5%) of the first 92 consecutive patients who underwent the procedure were retrospectively reviewed; the minimum follow-up duration was 2 years. The clinical outcomes were evaluated using the Japanese Orthopaedic Association (JOA) scoring system. Disc height, disc angle, cage positioning in the axial plane, and fusion status were radiographically evaluated. The mean follow-up period was 33.8 months. The mean improvement in the JOA score was 77.2%. Fusion was successful in 93% of the cases. According to the Farfan method, the mean anterior and posterior disc heights increased from 20.2 and 16.9% preoperatively to 35.9 and 22.7% at follow up, respectively (p < 0.01). The mean disc angle increased from 4.8° preoperatively to 7.5° at last follow-up examination (p < 0.01). Two cages were correctly placed to achieve bilateral anterior-column support in greater than 85% of the cases. The following complications occurred: hardware migration in two patients and deep infection cured by intravenous antibiotic therapy in one patient. Conclusions Unilateral TLIF involving the placement of two Brantigan cages per level led to good clinical results. Two Brantigan cages were adequately placed via a single portal, and reliable bilateral anterior-column support was achieved. Although the less invasive unilateral approach was used, the outcomes were as good as those in many reported series of posterior lumbar interbody fusion in which the Brantigan cages were placed via the bilateral approach.

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