scholarly journals Long-term outcomes of vertebral column resection for kyphosis in patients with cured spinal tuberculosis: average 8-year follow-up

2016 ◽  
Vol 24 (5) ◽  
pp. 777-785 ◽  
Author(s):  
Congcong Liu ◽  
Li Lin ◽  
Weixing Wang ◽  
Guohua Lv ◽  
Youwen Deng
Keyword(s):  
Sagittal Balance ◽  
Vertebral Column ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Adjacent Segment ◽  
Kyphosis Angle ◽  
Analog Scale ◽  
Vertebral Column Resection

OBJECTIVE The authors conducted a study to evaluate the long-term clinical and radiographic outcomes of vertebral column resection (VCR) for kyphosis in patients with cured spinal tuberculosis. METHODS This was a retrospective study. Between 2003 and 2009, 28 consecutive patients with cured spinal tuberculosis underwent VCR for kyphosis in which the target vertebra was removed completely. Autologous iliac crest bone graft or titanium mesh packed with autograft was placed into the osteotomy gap to reconstruct the spine for anterior column stability. Posterior pedicle screw fixation and fusion were typically performed. Radiographic parameters, including kyphosis angle and sagittal balance, were measured, and visual analog scale score, America Spinal Injury Association grade, Scoliosis Research Society outcome instrument (SRS-22) score, Oswestry Disability Index, patient satisfaction index, and long-term complications were evaluated. RESULTS This study included 12 males and 16 females, with an average age of 20.9 years at the time of surgery. The average follow-up was 96.9 months. No deaths occurred in this study. At the final follow-up, the kyphosis angle improved from the preoperative average of 70.7° to the final follow-up average of 30.2°, and the average kyphosis correction loss was 8.5°. The sagittal balance averaged 15.4 mm before surgery, 2.8 mm after surgery, and 5.4 mm at the final followup. Thirteen patients showed improvement of more than 1 America Spinal Injury Association grade. The visual analog scale, Oswestry Disability Index, and SRS-22 scores improved significantly, and the overall satisfaction rate was 92.9%. Adjacent-segment degeneration occurred in 3 patients. No severe instrumentation-related complications were observed. CONCLUSIONS The long-term safety and efficacy of the VCR technique for treating spinal tuberculosis-related kyphosis were favorable, and no severe late-stage complications appeared. Lumbar tubercular kyphosis showed a tendency for sagittal decompensation within the first 3 postoperative years. Cases of adjacent-segment degenerations were relatively few and mild without clinical symptoms.

scholarly journals The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

2020 ◽  
Author(s):  
Bingjin Wang ◽  
Wenbin Hua ◽  
Wencan Ke ◽  
Yukun Zhang ◽  
Xianlin Zeng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Allograft Bone ◽  
Titanium Mesh ◽  
Analog Scale ◽  
Bony Fusion ◽  
The Mean ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background: The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.Methods: We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.Results: All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up.Conclusions: Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

scholarly journals Congenital scoliosis treated with posterior vertebral column resection in patients younger than 18 years: longer than 10-year follow-up

2016 ◽  
Vol 25 (2) ◽  
pp. 225-233 ◽  
Author(s):  
Dong-Gune Chang ◽  
Jae Hyuk Yang ◽  
Jung-Hee Lee ◽  
Jin-Hyok Kim ◽  
Seung-Woo Suh ◽  
...  
Keyword(s):  
Cobb Angle ◽  
Vertebral Column ◽  
Congenital Scoliosis ◽  
Rigid Fixation ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Time Of Surgery ◽  
The Mean

OBJECTIVE There have been no reports on the long-term radiographic outcomes of posterior vertebral column resection (PVCR) in patients with congenital scoliosis. The purpose of this study was to evaluate the surgical outcomes and complications after PVCR and its long-term effects on correcting this deformity in children with congenital scoliosis. METHODS The authors retrospectively analyzed the medical records of 45 patients with congenital scoliosis who were younger than 18 years at the time of surgery and who underwent PVCR and fusion with pedicle screw fixation (PSF). The mean age of the patients at the time of surgery was 11.3 years (range 2.4–18.0 years), and the mean length of follow-up was 12.8 years (range 10.1–18.2 years). RESULTS The mean Cobb angle of the main curve was 46.5° before PVCR, 13.7° immediately after PVCR, and 17.6° at the last follow-up. For the compensatory cranial curve, PVCR corrected the preoperative Cobb angle of 21.2° to 9.1° postoperatively and maintained it at 10.9° at the last follow-up. For the compensatory caudal curve, the preoperative Cobb angle of 23.8° improved to 7.7° postoperatively and was 9.8° at the last follow-up. The authors noted 22 complications, and the overall incidence of complications was 48.9%. CONCLUSIONS Posterior vertebral column resection is an effective procedure for managing congenital scoliosis in patients younger than 18 years. Use of PVCR and fusion with PSF for congenital scoliosis achieved rigid fixation and satisfactory deformity correction that was maintained over the long term. However, the authors note that PVCR is a technically demanding procedure and entails risks for major complications and excessive blood loss.

A long-term follow-up study of anterior tibial allografting and instrumentation in the management of thoracolumbar tuberculous spondylitis

2008 ◽  
Vol 8 (1) ◽  
pp. 30-38 ◽  
Author(s):  
Halit Çavuşoğlu ◽  
Ramazan Alper Kaya ◽  
Osman Nuri Türkmenoğlu ◽  
Cengiz Tuncer ◽  
İbrahim Çolak ◽  
...  
Keyword(s):  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Spinal Instrumentation ◽  
Kyphotic Angle ◽  
Significant Correction ◽  
Anterior Tibial ◽  
Radical Debridement ◽  
The Mean

Object The purpose of this study was to determine the efficacy of anterior instrumentation following radical debridement and tibial allografting and its long-term progression in patients with multilevel spinal tuberculosis. Methods This prospective observational study was undertaken to analyze 22 patients with multilevel spinal tuberculosis (Pott disease) who underwent anterior radical debridement, decompression, and fusion using anterior spinal instrumentation and tibial allograft replacement between 1999 and 2001. Clinical outcomes were assessed using the American Spinal Injury Association (ASIA) Impairment Scale and a visual analog scale (VAS). Preoperative and postoperative plain radiographs were obtained, and the focal kyphotic angle of the surgically treated spinal segments and the overall sagittal and coronal contours of the thoracic and lumbar spine were evaluated in all patients. Results The mean follow-up time was 84 months (range 36–96 months). All patients demonstrated clinical healing of the tuberculosis infection. All patients showed evidence of successful bone fusion. The mean late postoperative kyphosis correction was 74% (range 63–91%). On average, 2° (range 0–5°) of loss of correction was noted in the local kyphotic angle postoperatively in late follow-up findings. Evaluation of the surgical effect on sagittal global contours showed a significant correction rate in thoracic, thoracolumbar, and lumbar regions. The mean late postoperative coronal plane alignment correction was 99%. The ASIA Impairment Scale scores demonstrated significant improvement in late follow-up results in our series. Surgical decompression also resulted in a dramatic reduction of overall pain in all patients (late postoperative VAS score 1.61 ± 0.81). Conclusions Anterior tibial allografting and instrumentation provide correction of the curvature, prevention of further deformation, improvement of sagittal and coronal balance, and restoration of neurological function in patients with spinal tuberculosis.

scholarly journals POSTERIOR VERTEBRAL COLUMN RESECTION (PVCR): A SAFE AND EFFECTIVE OPTION TO TREAT KYPHOSIS FROM SPINAL TUBERCULOSIS

2021 ◽  
Vol 20 (1) ◽  
pp. 42-46
Author(s):  
Plínio Braga Linhares Garcia ◽  
Luis Eduardo Carelli Teixeira da Silva ◽  
Alderico Girão Campos de Barros ◽  
Luiz Eduardo Pereira Costa Assis de Almeida
Keyword(s):  
Vertebral Column ◽  
Spinal Tuberculosis ◽  
Sensory Function ◽  
Level Of Evidence ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Effective Option ◽  
One Year ◽  
Clinical And Radiological Results

ABSTRACT Objective: To evaluate the clinical and radiological results of posterior vertebral column resection (PVCR) for the treatment of kyphosis from spinal tuberculosis. Methods: Retrospective study of a series of 14 cases, 9 female and 5 male, with a mean age of 28 years (1 to 64) at the time of surgery, with spinal tuberculosis with mean kyphosis of 56.42° (2° to 95°). Results: All patients underwent surgical treatment with PVCR, with a mean number of 2.57 (1 to 6) resected vertebrae and a mean number of instrumented vertebrae of 6.14 (4 to 8). The mean kyphosis correction was 64% after up to one year of follow-up. Prior to surgery, eight patients had signs of spinal cord impairment (ASIA score ranging from A to D), and six did not present any deficit of strength or sensory function (ASIA E). There was no neurological worsening and everyone with deficits improved by at least one degree on the scale. In the postoperative follow-up, bone consolidation was observed in all patients, except one. Among the intra- and postoperative complications, pleurotomy was the most prevalent. Conclusion: Posterior vertebral column resection has proven to be a safe and effective option for the treatment of kyphotic deformity from spinal tuberculosis. Level of evidence IV; Therapeutic studies - Investigation of treatment results.

scholarly journals A new surgical treatment for post-tubercular thoracic kyphosis, a retrospective study.

2020 ◽  
Author(s):  
Wenhao Hu ◽  
Huawei Liu ◽  
Fangqi Hu ◽  
Qi Wang ◽  
Teng Li ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Vertebral Column ◽  
Thoracic Kyphosis ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Operation Time ◽  
Osteotomy Site ◽  
Bony Destruction ◽  
The Mean

Abstract Background: In the late stage of Spinal tuberculosis, the bony destruction and vertebral collapse often leads to significant kyphosis, presenting clinically as a painful gibbus deformity, with increased instability, vertebral body translations. Deformity more commonly occurs and rapidly progresses in the thoracic spine. The surgical treatment of deformity in the thoracic region poses a challenge to the spine surgeon because its high neurological risk. Vertebral column decancellation，a new spinal osteotomy technique, is thought to be suitable for most patients with severe rigid kyphosis. In the current study, we report VCD technique as another surgical strategy for correction of post-tubercular thoracic kyphosis and evaluate the clinical and radiographic patient results.Methods: Between January 2016 and January 2018, 16 patients with post-tubercular thoracic kyphosis underwent the Vertebral column decancellation. Preoperative and postoperative Konstam’s angle were measured. Oswestry Disability Index(ODI) ,Visual analog scale(VAS) and American Spinal Injury Association(ASIA) were documented. The mean follow-up was 31.4 months Results: The average operation time was 226 minutes (range, 200–260 minutes) with a mean intraoperative blood loss of 466 mL (range, 400–580 mL).The Konstam’s angles decreased from 88.8°(range, 76°–103°)preoperatively to 19.0°(range, 9°–32°)at the final follow-up (P<0.01). The mean VAS score was reduced from preoperative 7.0(range, 6–8) to 1.7 (range, 1–3, P<0.01) and the ODI improved from 67.6% (range, 59%–77%) to 20.7% (range, 15%–33%, P<0.01). At final follow-up, there was radiographic evidence of solid fusion at the osteotomy site and fixed segments in all patients. Neurological function improved from ASIA scale D to E in 6 patients, C to D in 3 patients.Conclusion: Our results suggest that VCD is a safe and effective treatment option for post-tubercular thoracic kyphosis. This technique achieves higher correction and fusion rates with adequate decompression of neurological elements.

scholarly journals The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

2020 ◽  
Author(s):  
Bingjin Wang ◽  
Wenbin Hua ◽  
Wencan Ke ◽  
Yukun Zhang ◽  
Xianlin Zeng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Allograft Bone ◽  
Titanium Mesh ◽  
Analog Scale ◽  
Bony Fusion ◽  
The Mean ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis. Methods We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded. Results All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up. Conclusions Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

scholarly journals The efficacy of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis

2019 ◽  
Author(s):  
Bingjin Wang ◽  
Wenbin Hua ◽  
Wencan Ke ◽  
Yukun Zhang ◽  
Xianlin Zeng ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Spinal Injury ◽  
Spinal Tuberculosis ◽  
Allograft Bone ◽  
Titanium Mesh ◽  
Analog Scale ◽  
Bony Fusion ◽  
The Mean ◽  
Thoracolumbar Spinal Tuberculosis

Abstract Background The bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis has not been explained in detail. We aimed to analyze the efficacy of bony fusion of allograft bone using titanium mesh in the posterior-only surgical treatment of thoracic and thoracolumbar spinal tuberculosis.Methods We treated 32 thoracic or thoracolumbar tuberculosis patients by one-stage posterior debridement, allograft bone graft using titanium mesh, posterior instrumentation, and fusion from May 2011 to September 2015. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were analyzed preoperatively, postoperatively, and at final follow-up. The Cobb angles were recorded to evaluate the kyphosis correction and the loss of correction. The bony fusion was evaluated by X-ray and computed tomography images, and the bony fusion classifications were recorded.Results All patients had pain relief. The erythrocyte sedimentation rate, C-response protein, and hepatorenal function were normal at final follow-up. The American Spinal Injury Association neurological classification, visual analog scale, and Oswestry disability index scores were improved in all the patients. All patients achieved bone fusion. Twenty-eight patients achieved complete fusion (Grade I), whereas only four patients achieved partial fusion (Grade II). The preoperative Cobb angle was 33.6±9.3°. The Cobb angle was reduced to 10.6±2.6° postoperatively and was found to be 11.4±3.1° at the final follow-up. The mean angle correction was 23.0±8.9°, and the correction rate was 66.2±12.2%. The mean angle lost was 0.8±0.9°, and the lost rate was 5.8±5.4% at the final follow-up.Conclusions Allograft bone using titanium mesh in the posterior-only surgical treatment is effective for patients with thoracic and thoracolumbar spinal tuberculosis. It can correct kyphosis, and most patients can achieve complete bony fusion.

scholarly journals POSTERIOR VERTEBRAL COLUMN RESECTION IN MULTIPLE LEVELS IN CHILDREN WITH VERTEBRAL TUBERCULOSIS

2019 ◽  
Vol 18 (3) ◽  
pp. 217-221
Author(s):  
ALDERICO GIRÃO CAMPOS DE BARROS ◽  
LUIS EDUARDO CARELLI TEIXEIRA DA SILVA ◽  
MARCELO GLAUBER DA SILVA PEREIRA ◽  
ANDRE LUIZ LOYELO BARCELLOS ◽  
LUCAS ROCHA CAVALCANTI
Keyword(s):  
Neurological Deficit ◽  
Vertebral Column ◽  
Spinal Tuberculosis ◽  
Vertebral Column Resection ◽  
Posterior Vertebral Column Resection ◽  
Cord Injury ◽  
The Mean ◽  
Multiple Levels ◽  
Tuberculosis In Children

ABSTRACT Objective To evaluate the clinical and radiological results of posterior vertebral column resection in the treatment of kyphosis due to vertebral tuberculosis in children under 9 years of age with neurological deficit. Methods Retrospective study of a series of 5 cases, 4 females and 1 male, mean age of 4.7 years at the time of surgery, with spinal tuberculosis and mean kyphosis of 89 degrees. Results All patients underwent surgical treatment with PVCR in multiple levels, with a mean number of 3.6 resected vertebrae, mean surgical time of 359 minutes, mean postoperative stay of 21.2 days. The mean follow-up was 29 months. The mean kyphosis correction was 62.6%. Before surgery, all patients had signs of spinal cord injury, one of which did not present a deficit of strength or sensibility (ASIA E), but there were pyramidal signs and a history of falls. The other 4 had some degree of sensory-motor dysfunction, with ASIA score varying from A to D. Postoperative complications included two dehiscences of suture, one pneumothorax and one pneumonia, all with favorable evolution. Four patients progressed with neurological improvement and one of them had persistence of the neurological deficit until the last follow-up. Conclusions Multiple-level PVCR has proven to be a safe and effective option for the treatment of kyphotic deformity in spinal tuberculosis in children with neurological deficit. Level of evidence IV; Case Series.

scholarly journals Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study

2021 ◽  
Vol 9 (2) ◽  
pp. 94-105
Author(s):  
Naifeng Kuang ◽  
Xiaoyu Wang ◽  
Yuexia Chen ◽  
Guifeng Liu ◽  
Fan’e Kong ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Autonomic Function ◽  
Spinal Injury ◽  
International Standards ◽  
Olfactory Ensheathing Cell ◽  
Cord Injury ◽  
Long Term Follow Up

Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.

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