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.

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 The efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis

2020 ◽  
Author(s):  
Jiao Zhou ◽  
Quanyi Li ◽  
Yongchun Zhou ◽  
Qichun Song
Keyword(s):  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Clinical Manifestations ◽  
Adult Patients ◽  
Thoracic Spinal ◽  
Imaging Results ◽  
Single Posterior Approach ◽  
Posterior Debridement ◽  
Thoracic Spinal Tuberculosis

Abstract Background: The aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting, and instrumentation for the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was conducted on 88 adult patients with thoracic spinal tuberculosis between June 2013 and September 2017. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imaging results of the approach were subsequently analysed. Results: All patients were followed up for 40.6 ± 4.1 m (range, 36–48 m). Bony fusion was achieved in all bone grafts. The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). The postoperative and final-follow-up kyphosis angles were both significantly smaller than the pre-operative kyphosis angles (P<0.05). The postoperative angle correction rate reached 81.5%, and the postoperative angle loss only reached 4.1%. At the last follow-up, ASIA improvement was significant compared with the preoperative levels (P<0.05). Conclusion: The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.

scholarly journals Comparison of single posterior debridement, bone grafting, and instrumentation with single anterior debridement, bone grafting, and instrumentation in treatment of thoracic spinal tuberculosis

2019 ◽  
Author(s):  
Yongchun Zhou ◽  
Weiwei Li ◽  
Liqun Gong ◽  
Jiao Zhou ◽  
Jing Luo
Keyword(s):  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Operation Time ◽  
Anterior Debridement ◽  
Thoracic Spinal ◽  
Group A ◽  
Group B ◽  
Posterior Debridement ◽  
Thoracic Spinal Tuberculosis

Abstract Objective To explore the clinical effect of single posterior debridement, bone grafting, and instrumentation and single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis of adult patients. Methods: A retrospective analysis was made by involving 38 adult patients with thoracic spinal tuberculosis from between June 2013 and December 2015. Of the 38 patients, 21 patients were categorized in single anterior approach group and underwent single posterior debridement, bone grafting, and instrumentation (Group A). The remaining 17 patients were classified in single posterior approaches group (Group B), which received single posterior debridement, bone grafting and instrumentation. Clinical manifestations, laboratory and imaging results of the two groups were analyzed subsequently. Results: All patients were followed up for 23.9 ± 3.8 m (range, 19–36 m). Bony fusion was achieved in all bone grafts. The operation time and intraoperative blood loss in group B were significantly less than those in group A (P<0.05). The VAS scores, ESR, and CRP levels 6 weeks after operation and at the final follow-up were significantly lower than the preoperative levels (P<0.05). At the last follow-up, ASIA improvement no significant difference between groups (P>0.05). Furthermore, the postoperative and final-follow-up kyphosis angles in group B were both significantly smaller than those in group A (P<0.05). Group A had a postoperative angle correction rate smaller than group B, and its postoperative angle loss was greater than group B’s (P<0.05). Conclusion: Single posterior debridement, bone grafting, and instrumentation can achieve similar curative effect as single anterior debridement, bone grafting and instrumentation in the treatment of thoracic spinal tuberculosis, but also accompanied by additional advantages of shorter operation time and less bleeding .

scholarly journals One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation for treating mono-segmental lumbar and lumbosacral spinal tuberculosis in adult patients following minimum 5-year follow-up

2020 ◽  
Author(s):  
Zhenchao Xu ◽  
Xiyang Wang ◽  
Zheng Liu
Keyword(s):  
Bone Grafting ◽  
Spinal Tuberculosis ◽  
Adjacent Segment ◽  
Titanium Mesh ◽  
Titanium Mesh Cage ◽  
Single Segment ◽  
One Stage ◽  
Mesh Cage ◽  
Posterior Debridement

Abstract Background To evaluate the mid-long term outcomes of surgical management of mono-segmental lumbar and lumbosacral spinal tuberculosis (TB) by one-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation. Methods A total of 62 patients with mono-segmental lumbar or lumbosacral spinal tuberculosis were enrolled. One-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation was performed. Clinical and radiographic outcomes were compared and analyzed. Results All patients were followed up for an average of 75.0 ± 11.5 months and completely cured at the final follow-up. C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR) returned to normal within three months postoperatively. Postoperative Japanese Orthopedic Association (JOA) score, visual analog scale (VAS) and Oswestry Disability index (ODI) were significantly improved compared with preoperative values. Bony fusion occurred after an average of 9.8 ± 2.6 months. The lordosis angle and lumbosacral angle were increased from preoperative 20.4 ± 2.9° and 14.7 ± 3.4°to postoperative 32.8 ± 3.6° and 22.4 ± 5.5°, with the angle loss of 1.0 ± 0.7° and 0.8 ± 0.7° at the final follow-up, respectively. No significant differences between preoperative and postoperative adjacent segment disc height (DH) were found. Conclusions one-stage posterior debridement, titanium mesh cage bone grafting and single-segment fixation can be an effective and feasible treatment option for mono-segmental lumbar and lumbosacral spinal tuberculosis in adults. It may preserve lumbar normal motor units and decrease adjacent segment degeneration (ASD) with the advantages of minimally invasion and rapid postoperative rehabilitation.

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 The efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Zhi Yi ◽  
Qichun Song ◽  
Jiao Zhou ◽  
Yongchun Zhou
Keyword(s):  
Bone Grafting ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Clinical Manifestations ◽  
Adult Patients ◽  
Thoracic Vertebrae ◽  
Thoracic Spinal ◽  
Posterior Debridement ◽  
Thoracic Spinal Tuberculosis

AbstractThe aim of this study was to investigate the clinical efficacy of single posterior debridement, bone grafting and instrumentation for the treatment of thoracic spinal tuberculosis in adult patients. A retrospective analysis was conducted between June 2013 and September 2017of 88 adult patients with thoracic spinal tuberculosis. All patients were treated with single posterior debridement, bone grafting and instrumentation. The clinical manifestations and laboratory and imageological results were subsequently analysed. All patients were followed for 40.6 ± 4.1 months (range, 36–48 m). Bony fusion was achieved in all bone grafts of thoracic vertebrae. The visual analogue scale scores, erythrocyte sedimentation rate and C-reactive protein levels 6 weeks after surgery and at the final follow up were significantly lower than the preoperative levels (P < 0.05). The postoperative and final follow up kyphosis angles were both significantly smaller than the preoperative kyphosis angles (P < 0.05). The postoperative angle correction rate reached 81.5% and the postoperative angle loss reached only 4.1%. At the last follow up, American Spinal Injury Association improvement was significant, compared with the preoperative levels (P < 0.05). The single posterior approach can achieve satisfactory clinical outcomes in the treatment of thoracic spinal tuberculosis.

scholarly journals Single-stage posterior-only debridement, decompression and interbody fusion for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wence Wu ◽  
Zhechen Li ◽  
Renqin Lin ◽  
Shenglin Wang ◽  
Jianhua Lin
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Interbody Fusion ◽  
Spinal Tuberculosis ◽  
Operating Time ◽  
Single Stage ◽  
Allograft Bone ◽  
Titanium Mesh ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background To explore the clinical safety and efficacy of single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion combined for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses. Methods A total of 38 patients diagnosed with thoracolumbar spinal tuberculosis complicated with psoas abscesses underwent surgery via single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion from January 2010 to September 2016 were enrolled in the study. The clinical efficacy of the approach was assessed based on parameters including operating time, blood loss, Cobb angle, visual analogue scale (VAS) scores, Frankel grade, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Results The surgery duration was 224.4 ± 71.1 min with a blood loss of 731.8 ± 585.8 ml. The Cobb angle was corrected from 16.0 ± 15.4° preoperatively to 8.1 ± 7.4° postoperatively (P < 0.001, t = − 4.38), and returned to a level of 11.0 ± 8.5° at the final follow-up (P = 0.002, t = 3.38). Back pain was relieved, with the mean preoperative VAS of 3.5 ± 1.1 decreased to 0.7 ± 0.8 postoperatively (P < 0.001, t = 23.21) and then to 0.6 ± 0.5 at the final follow-up (P < 0.001, t = 17.07). Neurological function was improved in various degrees and psoas abscesses disappeared in all patients. The ESR and CRP decreased gradually after surgery and returned to normal at the final follow-up in all patients. All patients achieved bone fusion thoroughly and no recurrence of TB or surgical related complications was found at the final follow-up. Conclusion Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion is a safe and effective approach for the management of thoracolumbar spinal tuberculosis complicated with psoas abscesses.

scholarly journals Short-term outcome of lamina-sparing decompression in thoracolumbar spinal tuberculosis

2020 ◽  
Vol 33 (5) ◽  
pp. 627-634
Author(s):  
Gagandeep Yadav ◽  
Pankaj Kandwal ◽  
Shobha S. Arora
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Spinal Tuberculosis ◽  
Neurological Recovery ◽  
Central Type ◽  
Kyphosis Correction ◽  
Duration Of Surgery ◽  
Diseased Segment ◽  
Thoracolumbar Spinal Tuberculosis

OBJECTIVEThe authors sought to assess the outcomes of lamina-sparing decompression using a posterior-only approach in patients with thoracolumbar spinal tuberculosis (TB). In patients with spinal TB with paraplegia, anterior decompression yields excellent results because it allows direct access to the diseased part of the vertebra, but the anterior approach has related morbidities. Posterior and posterolateral decompression mitigate approach-related morbidities; however, these approaches destabilize the already diseased segment. Lamina-sparing decompression through a posterior-only approach is a modification of posterolateral and anterolateral decompression that allows simultaneous decompression and instrumentation while preserving the posterior healthy bony structure as much as possible.METHODSThirty-five patients with spinal TB underwent lamina-sparing decompression and instrumentation. Outcomes were determined by using a visual analog scale (VAS) and the Oswestry Disability Index (ODI) for functional assessment, the American Spinal Injury Association (ASIA) impairment grade for neurological assessment, blood loss and duration of surgery for surgical outcome assessment, and Cobb angles to measure kyphosis correction.RESULTSIn total, 35 patients (12 men and 23 women) with an average age of 35.8 ± 18.7 (range 4–69) years underwent lamina-sparing decompression. Eight patients had dorsal, 7 had dorsolumbar, 7 had lumbar, 9 had multifocal contiguous, and 4 patients had multifocal noncontiguous spinal TB; 33 patients had paradiscal Pott’s spine (tuberculous spondylodiscitis), and 2 had central-type disease. The average preoperative Cobb angle was 28.4° ± 14.9° (range 0°–60°) and the postoperative Cobb angle was 16.3° ± 11.3° (44° to −15°). There was loss of 1.6° ± 1.5° (0°–5°) during 16 months of follow-up. Average blood loss was 526 ± 316 (range 130–1200) ml. Duration of surgery was 228 ± 79.14 (range 60–320) minutes. Level of vertebral instrumentation on average was 0.97 ± 0.8 (range 0–4) vertebra proximal and 1.25 ± 0.75 (0–3) distal to the diseased segment. Neurological recovery during the immediate postoperative period occurred in 23 of 27 patients (85.1%). All patients had recovered at the final follow-up at 16 months. The preoperative ODI score improved from 76.4 ± 17.9 (range 32–100) to 6.74 ± 17.2 (0–60) at 16 months. The preoperative VAS score improved from 7.48 ± 1.16 (6–10) to 0.47 ± 1.94 (0–8). Surgical site infection occurred in 2 patients, and 1 patient had an intraoperative dural tear that was successfully repaired. One patient developed implant loosening at 3 months, which was managed by extended instrumentation.CONCLUSIONSTo achieve stability, lamina-sparing decompression allows fixation of lower numbers of vertebrae proximal and distal to the diseased segment. This method has a fair outcome in terms of kyphosis correction, good functional and neurological recovery, shorter surgical duration than conventional methods, and less blood loss.

scholarly journals Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses

2020 ◽  
Author(s):  
Wence Wu ◽  
Zhechen Li ◽  
Renqin Lin ◽  
Shenglin Wang ◽  
Jianhua Lin
Keyword(s):  
Blood Loss ◽  
Cobb Angle ◽  
Interbody Fusion ◽  
Spinal Tuberculosis ◽  
Operating Time ◽  
Single Stage ◽  
Allograft Bone ◽  
Titanium Mesh ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background: To explore the clinical safety and efficacy of single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion combined for the treatment of thoracolumbar spinal tuberculosis complicated with psoas abscesses.Methods: A total of 38 patients diagnosed with thoracolumbar spinal tuberculosis complicated with psoas abscesses underwent surgery via single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion from January 2010 to September 2016 were enrolled in the study. The clinical efficacy of the approach was assessed based on parameters including operating time, blood loss, Cobb angle, visual analogue scale (VAS) scores, Frankel grade, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP).Results: The surgery duration was 224.4 ± 71.1 min with a blood loss of 731.8 ± 585.8 ml. The Cobb angle was corrected from 16.0 ± 15.4° preoperatively to 8.1 ± 7.4° postoperatively (P < 0.001, t = -4.38), and returned to a level of 11.0 ± 8.5° at the final follow-up (P = 0.002, t = 3.38). Back pain was relieved, with the mean preoperative VAS of 3.5 ± 1.1 decreased to 0.7 ± 0.8 postoperatively (P < 0.001, t = 23.21) and then to 0.6 ± 0.5 at the final follow-up (P < 0.001, t = 17.07). Neurological function was improved in various degrees and psoas abscesses disappeared in all patients. The ESR and CRP decreased gradually after surgery and returned to normal at the final follow-up in all patients. All patients achieved bone fusion thoroughly and no recurrence of TB or surgical related complications was found at the final follow-up. Conclusion: Single-stage posterior-only debridement, decompression, allograft bone using titanium mesh and interbody fusion is a safe and effective approach for the management of thoracolumbar spinal tuberculosis complicated with psoas abscesses.

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