Humans ; Internal Fixators ; Spine ; surgery ; Tuberculosis, Spinal ; surgery

Casts, Surgical ; Humans ; Internal Fixators ; Spine ; surgery ; Tuberculosis, Spinal ; surgery

Humans ; Minimally Invasive Surgical Procedures ; methods ; Tuberculosis, Spinal ; classification ; surgery

OBJECTIVETo evaluate the clinical outcomes of primary anterior radical debridement, bone autograft, and sacral rod fixation for the treatment of tuberculosis of the lumbosacral segment.

METHODSFrom March 2004 to November 2008,11 patients with tuberculosis of the lumbosacral segments received antituberculosis medications for 2 to 3 weeks before anterior radical debridement, autologous iliac bone grafting, and internal sacral rod fixation. Among the patients, 5 patients were male and 6 patients were female, with an average age of (44.45 +/- 8.50) years (ranged from 29 to 56 years). The average time from stage of onset to operation was 11 months (ranged from 8 to 15 months). All the patients presented with various degrees of lower back pain; one patient experienced preoperative lower extremity radicular pain, while 2 patients experienced saddle area anaesthesia. However, only 6 patients exhibited mild to moderate tuberculous toxic reactions. All the patients were evaluated by plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI). The diagnosis of tuberculosis was made with reference to clinical and radiological findings. Surgery was performed when the toxic symptoms of tuberculosis were controlled and erythrocyte sedimentation rates (ESR) decreased to (37.2 +/- 9.6) mm/h (25 to 54 mm/h). Lumbosacral angle, visual analogue scale (VAS) scores, ESR, and neurological performance were assessed before and after surgery.

RESULTSAll surgical procedures were performed successfully without intra or postoperative complications. There were no instances of spinal tuberculosis recurrence. Patients were followed up for a mean of (19.64 +/- 5.43) months. The mean lumbosacral angle significantly increased from the preoperative mean (12.9 +/- 5.0) degrees to postoperative (21.5 +/- 6.1) degrees and at final follow-up (20.1 +/- 5.2) degrees (P < 0.001). The mean VAS scores and ESR significantly decreased from preoperative (7.3 +/- 1.2) score and (37.2 +/- 9.6) mm/h respectively to final follow-up (0.6 +/- 0.5) score and (10.5 +/- 2.3) mm/h respectively (P < 0.001). Bone fusion occurred in all patients at a mean of (9.0 +/- 1.9) months (ranged 6 to 12 months) after surgery. Three patients who had impaired neurological performance before surgery had normal neurological performance after surgery.

CONCLUSIONOur findings suggest that anterior radical debridement, interbody fusion, and sacral rod fixation can be an effective treatment option for lumbosacral segment tuberculosis.

Adult ; Debridement ; Female ; Humans ; Lumbosacral Region ; Male ; Middle Aged ; Sacrum ; surgery ; Spinal Fusion ; Tuberculosis, Spinal ; surgery

OBJECTIVETo investigate the mid-term outcome of operation for thoracolumbar tuberculosis. METHODS : Twenty-eight patiens with thoracolumbar tuberculosis underwent one stage anterior debridement,interbody fusion with bone graft and posterior pedicle screw internal fixation treatment from July 2006 to July 2011. There were 17 males and 11 females. Total 17 patients had nerve injuries ,including 6 cases of grade B, 5 cases of grade C, 6 cases of grade D according to Frankel classification. The poisoning symptoms of tuberculosis and recovery of spinal function were observed. The bone fusion and recovery of [umbar function were evaluated.

RESULTSAll the patients were followed up ,and the duration ranged from 39 to 85 months (mean 57 months). The clinical symptoms were controlled gradually, and the thoracolumbar back pain was alleviated after operation. Among the 17 patients with complications of nerve injuries, 3 patients were improved from preoperative grade B to postoperative grade D, 3 patients were improved from preoperative grade B to postopertive E, 5 patients with preoperative grade C and 6 patients with preoperative D were almostly recovered to normal after operation. According to JOA scoring system for curative effect evaluation, the excellent and good rate at the 3rd month, the 1st year, the 3rd year and the 5th year after operation were 67.86% ,82.14% ,85.71% ,89.29% and 91.30% respectively. The results at the 6th month and the 1st year had no statistical differences compared to the results at the 3rd month (P > 0.05); but the results at the 3rd year and the 5th year were better than that at 3 months after operation (P < 0.05); and the results between 3 yesrs and 5 years after operation had no statistical differences (P < O.05). The degeneration of adjacent segments were evaluated according to the California University (Universith of California at Los Angeles , UCLA) score. The degeneration rate was 53.57% (15/28) at the 3rd year after surgery, which was better than that before surgery. Twenty-three patients were followed up for 5 years ,and the degeneration rate was 86.96% (20/23) ,which was better than those of before surgery and 3 years after surgery.

CONCLUSIONThe surgical treatment for thoracolumbar spinal tuberculosis can achieve the thorough debridement, reconstruction of spinal stability, recovery of lumbar function and promote the functional recovery of the spinal cord, which is an effective method of treatment. However, the mid term follow-up showed that more severe degenerative changes were found in the postoperative adjacent segment.

Adult ; Aged ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; physiopathology ; surgery

During the period from January 1967 to December 1977, 244 cases of tuberculosis of the spine were operated on at the Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea. We followed up 176 cases from 6 months to 10 years and the average period was one year and ten months. (Radical curettage and anterior interbody fusion 129 cases, posterior fusion 20 cases, curettage without bone graft 21 cases, and combined anterior and posterior fusion 6 cases.) The results of those studies are as follows: 1) The incidence of Pott's-parplegia was 25% (61 cases) of the total cases. 2) Almost 41 cases (66%) of the total cases of Pott's parplegia have recovered well enough to return after operation to their previous work. 3) In children (below 15 years of age) 50 cases (87.7%) had satisfactory results with bony fusion and in adults 93 cases (94.9%). 4) In children 44 cases (77%) had healing of radiological activity after operation and in adults 104 cases (87%). 5) The younger the spine, the lower the fusion rate. Combined anterior and posterior fusion is the choice of treatment for tuberculosis of the spine in children. 6) Postoperative complications occured in 38 cases (16%) including wound infection, postoperative pneumonia, postoperative pneoumothorax, postoperative atelectasis, paralytic ileus, meningitis, cystitis, and failure in bone graft.
Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Human ; Infant ; Korea ; Male ; Middle Age ; Spinal Fusion ; Tuberculosis, Pulmonary/complications ; Tuberculosis, Spinal/complications ; Tuberculosis, Spinal/epidemiology ; Tuberculosis, Spinal/surgery*

This article reviews a large number of recent years' literatures about surgical treatment for children with spinal tuberculosis on the characteristics of children with spinal tuberculosis, and analyzes the development of surgical treatment for children with spinal tuberculosis. Then it summarizes the indications of surgical treatment for children with spinal tuberculosis, and analyzes the clinical effect of various surgical methods of spinal tuberculosis, assesses that anterior debridement combined with anterior and posterior interbody autografting can be a good growth rate and deformity correction. Pedicle fixation on the children with spinal tuberculosis is safe and feasible. The positive early surgery can control children kyphosis. Minimally invasive surgery is the development direction of treatment for children spinal tuberculosis.
Child ; Humans ; Internal Fixators ; Minimally Invasive Surgical Procedures ; Spine ; surgery ; Tuberculosis, Spinal ; surgery

OBJECTIVETo review our experience of anterior thoracoscopic decompression and reconstruction in the treatment of thoracolumbar vertebral fractures, tuberculosis and herniated disks, and to evaluate the feasibility and effectiveness of such procedures.

METHODSTwelve patients who underwent thoracoscopic decompression and reconstruction of the spine since June 2003 have been reviewed retrospectively.

RESULTSThere were 8 male and 4 female patients, with a median age of 48.4 years (range 32 to 74 years) with thoracolumbar vertebral fractures (8 patients), tuberculosis (3 patients) and herniated disks (1 patient). The average time for the thoracoscopy was 210 minutes (range 180 to 260 minutes). Blood loss averaged 600 ml (range 300 to 800 ml), and the median length of hospital stay was 12 days (range 7 to 18 days). One patient had to give up internal fixation because of severe osteoporosis. All patients were followed up at least 3 months. No severe postoperative complications occurred. No shift of the bone graft and internal fixator. Recovery of neural function was almost the same as open procedures.

CONCLUSIONThoracoscopic anterior procedures can be used safely and effectively in the treatment of thoracolumbar spine diseases. This minimally invasive approach might decrease procedure-related trauma, operative time, blood loss, and length of hospitalization and may also alleviate postthoracotomy pain.

Adult ; Aged ; Diskectomy ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Spinal Diseases ; surgery ; Spinal Fractures ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; Tuberculosis, Spinal ; surgery

OBJECTIVETo evaluate the influence of perioperative nutritional support on nutritional status of patients with thoracolumbar spinal tuberculosis.

METHODSForty-eight patients with thoracolumbar spinal tuberculosis (male 25 and female 23, aged from 35 to 60 years, with an average of 48.25 years) were randomized into two groups. Twenty-four patients nutritional support were increased intravenously for 14 days (7 days before and after operation) in experimental group. Twenty-four patients in control group were supplied with routine diet. The body weight, plasma concentrations of albumin and ESR were detected on the 7th day before operation and on the 7th day after operation. The total wound drainage was recorded and compared.

RESULTSBody weight and plasma concentrations of albumin on the 7th day after operation and those on the 7th day before operation were not significantly different in experimental group (P > 0.05). In control group, body weight and plasma concentrations of albumin on the 7th day after operation was lower than those on the 7th day before operation (P < 0.05). The total wound drainage of experimental group was less than that of control group (P < 0.05). ESR on the 7th day after operation was lower than that on the 7th day before operation in two groups (P < 0.05); but the decrease of ESR in experimental group was more than that in control group (P < 0.05).

CONCLUSIONNutritional support is beneficial to alleviating innutrition caused by tubercle bacillus and operation. It can promote the effects of operation and anti-tuberculotic drugs.

Adult ; Female ; Humans ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Nutritional Support ; Perioperative Care ; Thoracic Vertebrae ; surgery ; Tuberculosis, Spinal ; surgery

Combined Modality Therapy ; Humans ; Treatment Outcome ; Tuberculosis, Spinal ; drug therapy ; surgery