anterior debridement
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2021 ◽  
Author(s):  
Jing Xue ◽  
Tao Li ◽  
Yueming Song ◽  
Hao Liu ◽  
Limin Liu ◽  
...  

Abstract Background: There are many studies on the surgical treatment of lumbosacral tuberculosis, but both the anterior and posterior approaches present some shortcomings. This study aimed to evaluate the therapeutic efficacy of anterior debridement and bone graft, posterior fixation and fusion with navigation for L5-S1 tuberculosis with severe bone destruction. Methods: This was a retrospective study of 24 patients with severe tuberculosis in L5-S1 who underwent anterior interbody arthrodesis and posterior pedicle screw internal fixation by open approach under computer navigation between February 2011 and Novenmber 2016. The erythrocyte sedimentation rate(ESR), C-reactive protein level(CRP),visual analogue scale(VAS), and lumbosacral angle were compared between before surgery, after surgery, and at the final follow-up. The fusion status of bone graft was evaluated with computed tomography(CT).Results: The mean operation time was 244.58 minutes. The mean intraoperative blood loss was 413.75ml. The accuracy of screw placement was 96.43%. The mean follow-up period was 26.17 months. The average ESR, CRP, VAS, and lumbosacral angles were 65.96 mm/h, 52.93 mg/L, 4.96 points ,and 107.94°, respectively,at preoperative, 34.17 mm/h, 16.47 mg/L, 1.58 points, and 116.12°, respectively, after surgery, and 14.08 mm/h, 6.20 mg/L, 0.58 points, and 115.97°, respectively, at the final follow-up period. The differences of ESR, CRP, VAS are statistically significant (p < 0.05). The difference of lumbosacral angles before and after surgery is statistically significant (p < 0.05),but there is no statistically significant difference between after surgery and the final follow-up period (p>0.05). Nine patients with ASIA Grade D before surgery returned to Grade E by the final follow-up period. All patients achieved bone fusion.There was no recurrence of the disease. Conclusions: Anterior debridement and bone graft fusion combined with navigated posterior pedicle screw fixation is a safe and effective treatment option for patients with severe bone destruction in L5-S1 spinal tuberculosis.


2021 ◽  
Author(s):  
Shuang Xu ◽  
Yueming Song ◽  
Qing Wang ◽  
Gaoju Wang ◽  
Jin Yang ◽  
...  

Abstract Background The purpose of this retrospective study was to compare the clinical outcomes of anterior surgical management for cervical spinal tuberculosis by iliac bone grafts versus structural manubrium graft.Methods From January 2009 to September 2018, 23 patients with cervical spinal tuberculosis were treated with anterior debridement,autogenous structural bone graft and fixation at our spinal department. The patients were divided into 2 groups according to the different graft material,including iliac crest bone grafts in group A, structural manubrium grafts in group B. The clinical and radiographic results for the 2 groups were analyzed and compared. Results The mean duration of follow-up was 24 months. Bony fusion was achieved in all cases without failure of internal fixation. There were no significant differences between groups regarding the the operation time,blood loss,fusion time,neurological outcomes,and postoperative local Cobb angle (P>.05).However,the donor site complication rate of Group A was more than that of Group B. Postoperative ambulation time in group A was later than that of group B.The mean visual analog scale (VAS) for donor-site pain in group A was higher than group B at a week after surgery (P < 0.05).However,there was no significant difference between the 2 groups at last visit (P>.05).Conclusion Both iliac bone grafts and sternal manubrium grafts can effectively reconstruct anterior column defects in anterior surgery. However,structural sternal manubrium autografts has less complications associated with donor site morbidities than that of iliac bone.


2020 ◽  
Author(s):  
huijun zhang ◽  
zenghui lu ◽  
lin wei ◽  
chao ding ◽  
junsong yang

Abstract Study design:This is a retrospective studyObjective:The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis. MethodsWe performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.ResultsAll patients underwent operation successfully. The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and all the patients got bony spinal fusion within 4 to 8 months after surgery judging by spinal x-ray film.The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 18.2± 4.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients. Neurologic status of the 16 patients with preoperative neurologic defcit was 3 with grade A recovered to normal; 4 with grade B recovered to normal; 4 with grade C recovered to normal; 3 with grade A recovered to grade D; 1 with grade B recovered to grade D;1 with grade C recovered to D.ConclusionThe clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia or incomplete paralysis can be an effective and feasible treatment method.


2020 ◽  
Vol 25 (3) ◽  
pp. 400-404 ◽  
Author(s):  
Wence Wu ◽  
Zhechen Li ◽  
Renqin Lin ◽  
Hongjie Zhang ◽  
Jianhua Lin

2020 ◽  
Author(s):  
huijun zhang ◽  
zenghui lu ◽  
lin wei ◽  
chao ding ◽  
junsong yang

Abstract Purpose The purpose of this study was to evaluate the clinical efficacy of primary anterior debridement, bone graft fusion and internal fixation in the treatment of short segmental thoracic tuberculosis with paraplegia.Methods We performed a retrospective analysis of 16 adult patients with short segment thoracic spinal TB with paraplegia who underwent surgery between September 2013 to March 2017. All the 16 patients were treated using a single primary anterior debridement, bone graft fusion and internal fixation. Clinical manifestations, laboratory, neurological symptoms,bone fusion and imaging results were subjected to statistical analysis.Results All patients underwent operation successfully. The preoperative ESR and CRP level of all patients were 72.6 ± 27.5 mm/h and 75.7 ± 25.9 mg/L, which decreased to 15.9 ± 4.6 mm/h and 4.7 ± 2.0 mg/L at the final follow-up, respectively. The preoperative thoracic kyphosis angle were 30.7 ± 7.1°respectively. The corresponding postoperative angles were ameliorated significantly to 9.1 ±1.9°. During the follow-up, spinal paraplegia was significantly improved in all patients.The symptoms of chest and back pain were alleviated and disappeared at 1–6 months postoperatively.Patients were followed up for 24–48months (average, 35.6 ±9.6 months). Among 16 patients, no recurrence, and bone fusion was achieved at the final follow-up.Conclusion The clinical results of primary anterior debridement, bone graft fusion and internal fixation in the treatment of segmental thoracic tuberculosis with paraplegia were satisfactory.


2020 ◽  
Vol 134 ◽  
pp. e956-e967
Author(s):  
Yehui Liao ◽  
Rupei Ye ◽  
Qiang Tang ◽  
Chao Tang ◽  
Fei Ma ◽  
...  

2019 ◽  
Vol 41 (12) ◽  
pp. 1051-1058 ◽  
Author(s):  
Sen Yang ◽  
Donggui Wang ◽  
Jianzhong Xu ◽  
Fei Luo ◽  
Wenjie Wu ◽  
...  

2019 ◽  
Author(s):  
Yongchun Zhou ◽  
Weiwei Li ◽  
Liqun Gong ◽  
Jiao Zhou ◽  
Jing Luo

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 .


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